Skip to main content
Download PDF

From peer influence to parental roles: factors associated with teenage pregnancy in Dire Dawa city, Eastern Ethiopia

Reproductive Health volume 22, Article number: 63 (2025) Cite this article

Abstract

Background

Although teenage pregnancy causes a considerable challenge to young women, studies among sexually active teenagers and the influence of peers on teenage pregnancy are not widely available. This study aims to determine the prevalence of teenage pregnancy and the association between peer pressure and other factors of teenage pregnancy in Dire Dawa secondary school, Eastern Ethiopia.

Methods

Institutional-based cross-sectional study was conducted among 677 identified sexually active students from selected schools. Census was conducted on 2260 teenagers to identify sexually active teenagers using a stage cluster sampling technique. Sexually active teenagers were recruited using a simple random sampling method. Data was entered into EpiData-version 3.1 and exported to STATA version 16 for analysis. Modified passion regression was done to assess the association between of teenage pregnancy and predictor variables and significantly associated at p-value < 0.05.

Result

Out of the total sexually active females 135 (19.9%) were pregnant. Teenage pregnancy was higher among teenagers in the 18–19 (APR = 3.21, 95% CI: 2.10–5.18) age group, living with either of their biological parents (APR = 1.9, 95% CI: 1.29–2.69) and neither of the biological parents (APR = 2.7 95% CI: 1.39–3.34), teenagers who had sex due to peer pressure (APR = 2.01, 95% CI: 1.51–2.86) and not knowing the ovation time in the menstrual cycle (APR = 1.6, 95% CI: 1.07–2.28). Teenage pregnancy is lower among teens who have good parent-daughter interaction (APR = 0.6, 95% CI: 0.50–0.91).

Conclusion

Nearly one-fifth of the students experienced teenage pregnancy. Teenage pregnancy is higher amongst the age group of 18–19, living with either or neither of the parents, having sex due to peer pressure, not knowing the ovulation time, and lower among teens with good parent-daughter interaction. Teenage pregnancy in Dire Dawa is influenced by a combination of individual, peer, and family-related factors. Addressing these through school-based programs, community involvement, and family-centered interventions is crucial to reducing teenage pregnancy rates.

Peer Review reports

Background

The term"adolescence"or so-called"teenage"is a unique stage in every person’s life. It is a period of transition from childhood to adulthood [1] where rapid psychological and physical changes take place resulting in reproductive maturity among adolescents [2]. Many adolescents manage this transformation successfully while others engage in behaviours that place their well-being in danger, for example, sexual experimentation, exploration, and promiscuity [3]. According to the World Health Organization (WHO) when pregnancy occurs among teenage girls aged between 13 and 19 years it is referred to as teenage pregnancy indicating the girls have not reached legal adulthood [1].

Adolescent birth rates in sub-Saharan Africa Latin America, and the Caribbean remain the highest worldwide, at 104 and 63 births per 1000 adolescent girls, respectively. In sub-Saharan Africa, adolescent birth rates exceed 100 births per 1000 women aged 15–19 years in 23 countries. Ethiopia has one of the highest adolescent fertility rates in sub-Saharan Africa – 72.4 births for every 1000 young women aged 15–19 years [4]. In sub-Saharan Africa it is estimated that 35% of pregnancies among 15–19-year-olds are unintended pregnancies: of which two-thirds end in childbirth and a third result in induced abortion, often performed unsafely [5].

Teenage pregnancy is a major contributor to maternal and child mortality, and to the intergenerational cycle of ill health and poverty [6]. Girls aged 15–19 are two times more likely to die compared to women in their twenties and those under the age of 15 are five times more likely to die during childbirth [7]. Adolescent mothers are also inexperienced with childcare practices including maternal and infant health. Most maternal and child morbidity due to teenage pregnancy are linked to hypertensive disorder of pregnancy, infection, low birth weight, and preterm delivery [8]. Teenage pregnancy exposes women to problems that are less common in adult women such as obstetric fistula often leading them to lifelong consequences because their body growth is not yet completed [9]. Teenage pregnancy has also implications on educational opportunities; It leads to poor educational attainment and high school dropout [10].

In Africa, pre-marital sex is not acceptable due to cultural and religious reasons, especially for young women, unintended pregnancy commonly happens outside marriage. As a result, they are forced to undergo secret, unsafe abortions under unhygienic conditions performed by people who lack the necessary skills [11]. Due to the stigma and cultural sensitivity of pre-marital sex, people live in denial of how sex is common during the teenage years. According to the Ethiopian Demographic and Health survey, 9% of young women reported having sex before the age of 15 and an even higher percentage of women reported having sex before the age of 18 (40%) [12].

The government of Ethiopia including different Non-Governmental Organizations (NGOs) has taken many measures to reduce teen pregnancy and its consequences such as preventing early marriage, adolescent and reproductive health strategies, legalization of abortion, and awareness creation against harmful traditional practices [13]. However, still, teenage pregnancy is very common in Ethiopia, and it is an important demographic factor that makes the country the second most populous country in Africa [14].

Several factors come into play regarding teenage pregnancy, which is often associated with early marriage: In sub-Saharan Africa, one in every four girls has given birth by the age of 18 years [15]. Peer pressure is also a factor worthy of note when it comes to teenage pregnancy [16]. Many adolescents become sexually active at an early age when they do not know how to avoid unwanted pregnancies and sexually transmitted infections: To conform to the norms of their peers, increases the likely hood of early and unprotected sexual intercourse [17].

Studies showed other factors contribute to teenage pregnancy such as the educational status of parents, economic status, family structure, parent-daughter communication, age, media, fertility knowledge, lack of knowledge about Family Planning (FP), contraceptive non-use factors determining teenage pregnancy [10, 14, 18,19,20,21,22]. Despite these, several gaps in the previous literature on teenage pregnancy among adolescents were identified. Studies have included all adolescents (both sexually active and not active) in the denominator and hence might underestimate the actual magnitude of teenage pregnancy. When the rate is recalculated including only sexually active adolescents it is found to have the highest rate of pregnancy, arguing for continued focus on sexually active adolescents to assess teenage pregnancy. To reduce adolescent pregnancy, it is imperative to identify all associated factors comprehensively and focus on sexually active teenagers as well as the effect of peer pressure to fully understand factors surrounding teenage pregnancy. Hence, this study is aimed to investigate and provide information that fills identified gaps in the prevalence and associated factors of teenage pregnancy among secondary school adolescents in Dire Dawa, eastern Ethiopia.

Methods and materials

Study setting and period

A cross-sectional study was conducted in Dire Dawa city from Nov 4–18, 2020 among secondary school female students. Dire Dawa is located in the eastern part of Ethiopia 515 km away from Addis Ababa. Dire Dawa is one of the two federal cities in Ethiopia. Based on the 2012 estimation made by the Central Statistics Agency of Ethiopia, Dire Dawa has a total population of 506,639, of which 248,253 (49%) were males and 258,386 (51%) were females. Out of the total population, 343,490 live in urban and 163,150 live in rural areas. According to the 2019 statistical report of the Dire Dawa education bureau, there are 21 secondary schools (13 private and 8 governmental) and 9 preparatory (6 private and 3 governmental) schools in the city. A total of 5,534 female adolescent students aged 15–19 years were enrolled in secondary school for the 2020 academic year.

Sample size determination

All selected sexually active female students in secondary school in Dire Dawa city were included in this study. To determine the sample size for this study, the outcome variable and various factors significantly associated with the outcome variable were considered. The final sample size was estimated based on the first and second specific objectives. Separate calculations were made for the first and second specific objectives, a larger sample size was used overall. For the first objective, the sample size was determined by using a single proportion sample size formula considering the following assumptions; 95% confidence interval (CI), 3% margin of error, and 7.7% proportion of teenage pregnancy were taken from a previous study conducted in Arba Minch town, Ethiopia (10). A design effect of 1.5 and 15% of non-responses rate resulted in 696.

Sampling techniques and procedure

For this study participants were selected based on their sexual activity. To identify sexually active teenage girls, a census was conducted among all female students (both sexually active and inactive) in the selected schools. Therefore the prevalence of 30.8% of sexually active teenagers from a previous study conducted in Bahirdar town [23] among female secondary school adolescents was considered to estimate the sample for the census and resulted in a sample size of 2260 (Fig. 1).

Fig. 1
figure 1

Illustration of selecting sexually active female teenagers in secondary school, Dire Dawa, Eastern Ethiopia

Full size image

A single-stage cluster sampling technique was used to select a representative sample of students from the selected schools. There were 30 secondary schools in the city (21 high schools and 9 preparatory schools) and among these five schools were selected by simple random sampling method. Census was done to identify sexually active female teenagers and data were collected from all female secondary students (2260) in the selected schools. Finally, from surveyed 2260 students, those who reported being sexually active teenagers were identified by using a simple random sampling method until the required sample size (696) was reached and used for the analysis of this study (Fig. 2).

Fig. 2
figure 2

Sampling procedure for selection of sexual active secondary schools female students in Dire Dawa city, Eastern Ethiopia

Full size image

Data collection tool and measurements

A structured- self-administered questionnaire was used for data collection. The tool was adopted from the EDHS data collection tool, adolescent SRH toolkit, and other relevant previous published studies [10, 19, 24, 25]. Initially, the questionnaire was developed in English and then translated into Amharic, Afan Oromo, and Af- Somali, and then it was back-translated into English to check for consistency. A pretest was done among female students from non-sampled schools. Following that, modifications were made to improve the clarity and content of the questions. The data was collected by 8 trained female data collectors and 2 two supervisors monitored the whole data collection process in the selected secondary schools. Before data collection, two days of training were given for data collectors and supervisors on the objective of the study, the content of the questionnaire, assenting, and consent processing. Regular monitoring for completeness, consistency, and accuracy of the data was held daily on each day of the data collection period by the assigned supervisors.

A structured questionnaire was used to gather data on participants’ socio-demographic characteristics, family characteristics, psychosocial factors, and sexual and reproductive health (SRH) behaviors. Teenage pregnancy is the outcome variable in this study and was measured by the item “Have you ever experienced a pregnancy that resulted in a miscarriage, abortion, live birth, or stillbirth?"The responses were categorized as"1” yes and “0” no [10]. A sexually active is a person who had penetrative sexual intercourse (vaginal) at least once before the study [26]. The family wealth index was done by the Principal Component Analysis (PCA) method by considering locally available household assets and categorizing them into five quintiles (lowest, second, middle, fourth, or highest) [12]. Knowledge of contraception was assessed through awareness of at least one method. Knowledge about the fertile period during the menstrual cycle was an independent variable in this study adapted from literature [12] measured through a “yes- no “question, “From one menstrual period to the next, are there certain days when a woman is more likely to become pregnant? And when are those days in the menstrual cycle?, Then responses were recorded to 1 = Knowledgeable(if she answers the letter of the choice that contains the time 4 days before and after the 14 th day of her first menstrual cycle) and 0 = Not Knowledgeable (if otherwise).

Parent–daughter interaction was assessed through questions regarding communication about sexuality, relationships, and love with parents. It was measured through the following 4 questions adapted from previous literature [10]. Do your parents communicate with you on issues related to sexuality, love, and friendship openly? Do your parents know about your love or sexual partner? Do your parents follow you where and with whom you stay when you are out of home? The response to each question was categorized as 1 = yes and 0 = no then, the median score from the four questions was computed and labeled as 1 = poor interaction (if scored ≤ 1) and 2 = good interaction (if scored > 1).

Statistical analysis

The collected data was checked for its completeness before data entry. Across checking it was coded and entered into Epi-Data version 3.1 and then exported to STATA version 16 statistical software for analysis. In addition, the frequency was run to check for any missing values and checked accordingly. A descriptive analysis was done and the result was presented by narration, tables, and graphs. Modified Poisson regression analysis was used to identify factors associated with the outcome variable. Those Variables in bivariate analysis whose p-value is less than 0.25 (p < 0.25) were retained in the final model. Crude prevalence ratios (CPRs) and adjusted prevalence ratios (APRs) were calculated with 95% confidence intervals. The multi co-linearity test was carried out using the coefficients’ covariance matrix and only variables with covariance < 0.5 were included.

Result

Socio-demographic characteristics

A total of 2260 participants were surveyed of whom 1564 were not sexually active and excluded from the analysis. From a total of 696 sexually active female teenagers, 677 sexually active female teenagers aged 14–19 years were eligible and identified for analysis, which makes a response rate of 97.3%. The mean age of respondents was 17.6 (SD ± 1.05) years. Four hundred two (55.4%) of the participants were found in the age group of 18–19 years and 643 (95%) were single. Almost all 660 (97%) of the participants are from the urban area and 335 (49.48%) of them are orthodox religious followers. Most were in Grade 12 (54%) and regarding the family wealth quintile 155 (23%) were in the middle wealth quintile (Table 1).

Table 1 Socio-demographic characteristics of teenagers in a secondary school of Dire Dawa city, Eastern Ethiopia, 2020
Full size table

Parenting and family-related factors

Family and parenting-related characteristics of teenagers were assessed; 36 and 52% of respondents’ fathers and mothers have not attended formal education respectively. Nearly three fourth of the teenagers reported that they lived with both of their parents. Good parent-daughter interaction was reported by more than half (55%) of the teenagers (Table 2).

Table 2 Parenting and family-related characteristics of teenagers in secondary schools of Dire Dawa city, Eastern Ethiopia, 2020
Full size table

Sexual and reproductive health characteristics

Four hundred seventy-two (70%) had their menses between the age of 13–15. Regarding the knowledge about ovulation 475 (70.1%) of female students didn’t know the ovulation time in their menstrual cycle. Nearly three-fourth (71.9%) of the teenagers reported having their first sexual debut before the age of 18. The mean age at first sexual intercourse is 16.8 ± (0.04). The minimum and maximum age during their first sex were 12 and 19 respectively. The means of female teenagers for their first sexual encounter among 446 (68.8%) female teenagers was a desire to have sex. 641(94.7%) of the participants knew at least one type of contraceptive method and oral pills were the most known (95.4%) contraceptive method. Ever use of contraceptive methods was reported by 282(41.7%) female students. Ninety-one (13.5%) of teenagers have a history of substance use in their lifetime (Table 3).

Table 3 Knowledge and SRH-related characteristics of sexually active teenagers in secondary schools of Dire Dawa city, Eastern Ethiopia, 2020
Full size table

Magnitude of teenage pregnancy

One hundred thirty-five (19.94%, 95% CI: 16.9–23) teenagers reported ever being pregnant and among this 13 (9.6%) were pregnant at the time of the survey. Of 115 (85%) the pregnancy was unplanned and more than half, 70 (51.9%) get pregnant for the first time before the age of 18 (Fig. 3). The mean age of the first pregnancy was 17.3 ± 0.07 years.

Fig. 3
figure 3

The proportion of age at first pregnancy among each age category among secondary school female students in Dire Dawa city, Eastern Ethiopia, 2020

Full size image

Factors associated with teenage pregnancy

After controlling the possible confounders, the prevalence ratio of teenage pregnancy in age groups of (18–19 years) was 3.2 times more likely to become pregnant than teenagers in age groups of 15–17 years (APR = 3.21, 95% CI:2.10–5.18). Teenagers living with either of their biological parents and those living with neither of their biological parents are 1.9 (APR = 1.9, 95% CI: 1.29–2.69) and 2.7(APR = 2.7 95% CI: 1.39–3.34) times more likely to experience teenage pregnancy respectively. Teenagers who did not know ovulation time in the menstrual cycle were 1.6 times more likely to experience pregnancy than those who did know (APR = 1.6, 95% CI: 1.07–2.28). Teenage who have engaged in sexual activity by peer pressure were 2 times more likely to become pregnant than their counterpart (APR = 2.01, 95% CI: 1.51–2.86). Teenagers who had good parent-daughter interaction were 40% (APR = 0.6, 95% CI: 0.50–0.91) times less likely to experience teenage pregnancy compared to teenagers with poor parent-daughter interaction (Table 4).

Table 4 Analysis of determining factors of teenage pregnancy among secondary school female students in Dire Dawa city, Eastern Ethiopia, 2020
Full size table

Discussion

Teenage pregnancy represents an important public health issue in the region of developing countries as a majority of the total number of teenage pregnancies is happening in these countries. The prevalence of teenage pregnancy extremely varies in different countries. Some of the reasons for the difference could be variations in the socio-demographic, sexual, and reproductive health characteristics of the respondents. This study showed that the prevalence of teenage pregnancy among sexually active female teenagers was 19.9%. Age, living arrangements, knowledge of the ovulatory cycle, peer pressure, and good parent-daughter communication were significantly associated with teenage pregnancy. The prevalence of this study was confirmed with other studies conducted in Assosa, findings from the EDHS 2016 report of Somali region and Kenya which showed that the prevalence of teenage pregnancy is 20.4% [20], 19% [12], and 23.3% [27] respectively.

This could be due to similarities with some of the reproductive characteristics of the teenagers in the study area. For instance, the study in Assosa, Ethiopia showed that 71.6% of teenagers had their first sexual encounter before the age of 18 which is almost similar to our finding in this study (71.9%). Additionally, the same finding was reported regarding the range of first sexual intercourse by age which is 12–19 years in both of the studies. The median age of first sexual intercourse might come into play as a factor for the comparable magnitude of teenage pregnancy. The median age at first sexual intercourse in the national report of the Somali region was 17 years old which is an equivalent finding to our study.

This finding is much higher than the study conducted in Arbaminch town, Ethiopia which is 7.7% [10], and Cameroon 5.2% [28]. The possible reason for the discrepancy is these studies included all adolescents irrespective of the risk of pregnancy (included both sexually active and inactive teenagers). More than half of the study participants in the aforementioned studies were not sexually active and were included in the denominator for calculation which might have underestimated the proportion of pregnancy among teenagers. Whereas this study was conducted on sexually active teenagers only since the risk of pregnancy among these populations is higher among teenagers who have no history of sexual activity.

This finding is also higher than those of the studies conducted in the national report on teenage pregnancy 13.0% [12] and in Nigeria 5.7% [29]. The variation could be due to the presence of some socio-demographic, sexual, and reproductive characteristics of participants since the national demographic survey includes both rural and urban settings. Whereas some of the shreds of evidence showed that rural women begin having sexual intercourse earlier than urban women which further leads to the early experience of pregnancy. However, this study was conducted in urban region of Dire Dawa city. On the other hand, the age range of the study population in Nigeria and Cameroon included teenagers 10–19 and 13–19 years whereas this study included those in the age range of 14–19 years, as the probability of being pregnant, is higher among late adolescents stage than the early stage.

Our study has found a lower proportion compared with the study conducted in northeast Ethiopia [14] and northwest Cameroon [30]. The aforementioned study was conducted in one of the rural districts where early marriage is prevalent and as a result, leads to a high prevalence of early pregnancy. Marriage might force teenagers to curtail their education leaving them with no skills to prevent pregnancy.

In this study, the risk of teenage pregnancy was 3.2 times higher for older teens (aged 18–19) compared with younger teens (aged 14–17 years). This finding is consistent with the study conducted in Kenya [27], a national study in Ethiopia [12], northeast Ethiopia [14], Assosa [20], Tigray [13]. This is not surprising given that the proportions of teenagers who have started their sexual activity as well as longer exposure to biological factors and social factors increase with age [19]. As age increases the risk of being pregnant also increases because they have been already engaged in sexual relations and getting into marriage. There are significantly different views on sexual activities during the adolescent years. Younger adolescents were significantly more conservative in their views than older participants [31].

The relationship between parent and their children influences teenage pregnancy as it determines the level of information passed to their daughters about pregnancy. In the current study, teenagers who lived with either of their biological parents and neither of their biological parents were 1.8 and 2.1 times risk to be exposed to teenage pregnancy compared to those who were living with both biological parents respectively. This finding is consistent with the study done in Arbaminch town and Ghana [10, 32]. The possible reason could be that teens that live with both biological parents have good parental control and communication about sexual and reproductive issues so that they can get support from their families that minimize their chance of exposure to sexual experience. Other studies are supportive of the relationship between family structure and initiation of sexual intercourse in early adolescence as single parenting influences the initiation of detrimental behavioural patterns in children leading to sexual initiation and unwanted pregnancy [33, 34].

The fact that knowing about the fertile period of the menstrual cycle to prevent pregnancy is strongly supported by the findings from this study. The proportion of teenage pregnancy who know about the fertile period was 14 and 22% of teenage pregnancy was among teenagers who do not know about the fertile period. Teens who don’t know the fertile period of the menstrual cycle had higher risk of being exposed to teenage pregnancy than their counterparts. The finding is in line with the national study done in Ethiopia [35] Malawi and Ghana [36, 37]. The possible reason may be that ovulation cycle knowledge helps them better understand to avoid unprotected sexual intercourse during fertile days and prevent the occurrence of unwanted pregnancy.

Teens living under good parent-daughter interaction regarding issues of sexuality, love, and pregnancy were less risk to experience teenage pregnancy compared to those who have poor parent-daughter interaction. This finding is in agreement with other studies conducted in Ethiopia and Jamaica. Good interaction between parents and adolescents enables parents to openly discuss and address challenges faced by teenagers ultimately enhancing communication and parent involvement in teenage pregnancy prevention mechanisms. The evidence points to Parent–child relationships that affect the likelihood of sexual initiation [38] and are strongly associated with a child’s safer sex practices, including condom use and delayed sexual debut [39, 40].

The findings of this study lend credibility to the hypothesis that having sex due to peer pressure contributes to the occurrence of teenage pregnancy. This is further supported by studies done in Uganda and Ghana [32, 41] that have postulated that peer pressure places teens at a higher risk of teenage pregnancy. Peers play an important role in teenagers’ lives; teenagers with sexually active friends are more likely to have sex through the influence of their age group leading to risky behaviour and unprotected sexual activity which may lead to pregnancy. Adolescents spend more time with their peers rather than their parents which becomes a prominent motivation for decisions [42]. A study showed that teens rely on their peers for information so that they can be accepted by in particular social group [43]. Peer pressure and fear of rejection by friends are deemed to be unfavorable conditions for adolescents; for them being in such group is more important rather than being disliked by their peers. For these reasons, teens engage in high-risk sex activities to access a group [44]. Sometimes teen gets misguided by advice from peers that to keep or persuade their boyfriend to marry them is to have sex with him to bear a child for him [45]. This indicates it is essential empowering girls to resist sexual intercourse influenced by building their self-esteem and life skills.

Conclusion

Teenage pregnancy is high indicating more to be done to ensure that teenage pregnancy prevention is effective and improves teenagers’ reproductive health. Age, living arrangement of parents, knowledge of the ovulatory cycle, the influence of peer pressure to have sex and parent-daughter interaction were found to have a statistically significant association with teenage pregnancy.

Recommendation

The factors driving teenage pregnancy are complex and require multifaceted interventions. In light of these findings The establishment of ASRH clubs or peer education groups in schools where students can receive support, engage in discussions, and access resources related to sexual and reproductive health might be able to reduce teenage pregnancy. Providing knowledge and reinforcing positive social norms through various types of abstinence, and recreation to decrease high-risk behaviour (sexual activity without contraceptive use) among teens to prevent teenage pregnancy in schools should be a priority. School-based peer-to-peer sexuality education programs and training on life skills to build up self-esteem should be implemented.

Parents and guardians should be mindful of the importance of encouraging open communication with their teens to help them understand with misconceptions they encounter regarding fitting with peers and information on sexual and reproductive health. Parents should be authorized to understand the struggles that comes with their age and environment as well.

Limitations of the study

Knowledge about contraception is not measured in comprehensive questions. Since the experience of pregnancy was collected through self-report, there might be underreporting of pregnancies and providing responses deemed socially acceptable. Due to some questions related to sexual, the study could potentially introduce social desirability bias.

Availability of data and materials

The analyzed data for this study could be obtained from the corresponding author based on reasonable request.

Abbreviations

AOR:

Adjusted odds ratio

CI:

Confidence interval

CPR:

Crude odds ratio

EDHS:

Ethiopian Demographic Health Survey

FMOH:

Federal Ministry of Health

FP:

Family planning

IHRERC:

Institutional Health Research Ethics Review Committee

LMICs:

Low- and middle-income countries

SRH:

Sexual and reproductive health

SSA:

Sub-Saharan Africa

WHO:

World Health Organization

References

  1. WHO. Adolescent pregnancy: adolescence is a time of opportunity during which a range of actions can be taken to set the stage for healthy adulthood: fact sheet. Geneva: World Health Organization; 2014.

    Google Scholar 

  2. Esere MO. Effect of Sex Education Programme on at-risk sexual behaviour of school-going adolescents in Ilorin. Nigeria Afr Health Sci. 2008;8(2):120–5.

    PubMed  Google Scholar 

  3. Kapinga OS, Hyera DF. Pupils’ perceptions of sex and reproductive health education in primary schools in Tanzania: a phenomenological study. J Educ Pract. 2015;6(6):106–13.

    Google Scholar 

  4. Jones N, Tefera B, Stephenson J, Gupta T, Pereznieto P, Emire G, et al. Early marriage and education: the complex role of social norms in shaping Ethiopian adolescent girls’ lives. Country Report: Shaping Policy for Development. 2014;1:1–103.

    Google Scholar 

  5. Bankole A, Malarcher S. Removing barriers to adolescents’ access to contraceptive information and services. Stud Fam Plann. 2010;41(2):117–24.

    Article  PubMed  Google Scholar 

  6. Kassa GM, Arowojolu A, Odukogbe A, Yalew AW. Prevalence and determinants of adolescent pregnancy in Africa: a systematic review and meta-analysis. Reprod Health. 2018;15(1):1–17.

    Article  Google Scholar 

  7. Omar K, Hasim S, Muhammad NA, Jaffar A, Hashim SM, Siraj HH. Adolescent pregnancy outcomes and risk factors in Malaysia. Int J Gynecol Obstet. 2010;111(3):220–3.

    Article  Google Scholar 

  8. Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, WHO Multicountry Survey on Maternal Newborn Health Research Network, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG. 2014;121(Suppl 1):40–8.

    Article  PubMed  Google Scholar 

  9. Purandare CN, Adanu R. World Report on Women’s Health 2015. Int J Gynecol Obstetrics. 2015;131:1–174.

    Google Scholar 

  10. Mathewos S, Mekuria A. Teenage pregnancy and its associated factors among school adolescents of Arba Minch Town, Southern Ethiopia. Ethiop J Health Sci. 2018;28(3):287–98. https://doiorg.publicaciones.saludcastillayleon.es/10.4314/ejhs.v28i3.6.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Krugu JK, Mevissen F, Münkel M, Ruiter R. Beyond love: a qualitative analysis of factors associated with teenage pregnancy among young women with pregnancy experience in Bolgatanga, Ghana. Cult Health Sex. 2017;19(3):293–307.

    Article  PubMed  Google Scholar 

  12. CSA. EDHS Program ICF Rockville M, USA Ethiopian Demographic and Health Survey. CSA and ICF, Addis Ababa, Ethiopia and Rockville, MD, USA. 2017; vol. 201,.

  13. Ayele BGK, Gebregzabher TG, Hailu TT, Assefa BA. Determinants of teenage pregnancy in Degua Tembien District, Tigray, Northern Ethiopia: a community-based case-control study. PLoS ONE. 2018;13(7):e0200898.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Habitu YA, Yalew A, Bisetegn TA. Prevalence and factors associated with teenage pregnancy, Northeast Ethiopia, 2017: a cross-sectional study. J Pregnancy. 2017;2018:2018.

    Google Scholar 

  15. Nugent R. Youth in a global world. World. 2005;1(27):1845.

    Google Scholar 

  16. Maxwell C, Chase E. Peer pressure–beyond rhetoric to reality. Sex Educ. 2008;8(3):303–14.

    Article  Google Scholar 

  17. Chandra-Mouli V, Camacho AV, Michaud P-A. WHO guidelines on preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries. J Adolesc Health. 2013;52(5):517–22.

    Article  PubMed  Google Scholar 

  18. Alemayehu T, Haider J, Habte D. Determinants of adolescent fertility in Ethiopia. Ethiop J Health Dev. 2010;24(1):30–8.

    Article  Google Scholar 

  19. Ayele B, Gebregzabher T, Hailu T, Assefa B. Determinants of teenage pregnancy in Degua Tembien District, Tigray, Northern Ethiopia: a community-based case-control study. PLoS ONE. 2018;13(7): e0200898.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Beyene A, Muhiye A, Getachew Y, Hiruye A, Mariam DH, Derbew M, et al. Assessment of the magnitude of teenage pregnancy and its associated factors among teenage females visiting Assosa General Hospital. Ethiop Med J. 2015;2:25–37.

    Google Scholar 

  21. Birhanu BE, Kebede DL, Kahsay AB, Belachew AB. Predictors of teenage pregnancy in Ethiopia: a multilevel analysis. BMC Public Health. 2019;19(1):601.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Mitiku M, Teferi M, Ayalew A, Tesfay M. Determinants of teenage pregnancy and motherhood in Ethiopia: analysis of the Ethiopian Demographic Health Survey 2016. Res Rev J Med. 2019;8(3):47–53.

    Google Scholar 

  23. Mulugeta Y, Birhane Y. Factors associated with pre-marital sexual debut among unmarried high school female students in Bahir Dar town, Ethiopia: cross- sectional study. Reprod Health. 2014;11:40. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/1742-4755-11-40.

    Article  PubMed Central  PubMed  Google Scholar 

  24. EDHS E. demographic and health survey 2016: key indicators report. The DHS Program ICF. 2016.

  25. UNFPA U, WHO. Adolescent sexual & reproductive health toolkit for humanitarian settings. A companion to the Inter-agency field manual on reproductive health. 2009.

  26. Behulu GK, Anteneh KT, Aynalem GL. Premarital sexual intercourse and associated factors among adolescent students in Debre-Markos town secondary and preparatory schools, north west Ethiopia, 2017. BMC Res Notes. 2019;12(1):95.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Omoro T, Gray SC, Otieno G, Mbeda C, Phillips-Howard PA, Hayes T, et al. Teen pregnancy in rural western Kenya: a public health issue. Int J Adolescence Youth. 2017;23(4):399–408.

    Google Scholar 

  28. Gabriel ESE, Halle-Ekane GE, Isah M, Wirsiy FS, Lebaga MLN, Siysila ND, et al. Prevalence and associated factors of teenage pregnancy among secondary and high school students in the Tiko Health District, South West Region. Cameroon J Biosci Med. 2020;08(09):99–113.

    Google Scholar 

  29. Aderibigbe SA, Araoye MO, Akande TM, Musa OI, Monehin JO, Babatunde OA. Teenage pregnancy and prevalence of abortion among in-school adolescents in North Central, Nigeria. Asian Soc Sci. 2011;7(1):122–7.

    Google Scholar 

  30. Donatus L, Sama DJ, Tsoka-Gwegweni JM, Cumber SN. Factors associated with adolescent school girl’s pregnancy in Kumbo East Health District North West region Cameroon. Pan Afr Med J. 2018;31:138.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Mushwana L, Monareng L, Richter S, Muller H. Factors influencing the adolescent pregnancy rate in the greater Giyani Municipality, Limpopo Province-South Africa. Int J Africa Nursing Sci. 2015;2:10–8.

    Article  Google Scholar 

  32. Bedzo JY, Manortey S. factors influencing teenage pregnancy in the lower Manya Krobo municipality in the Eastern Region of Ghana: a cross-sectional study. Open Access Library J. 2019;6:1–17.

    Google Scholar 

  33. Flewelling RL, Bauman KE. Family structure as a predictor of initial substance use and sexual intercourse in early adolescence. J Marriage Fam. 1990;52(1):171–81.

    Article  Google Scholar 

  34. Day RD. The transition to first intercourse among racially and culturally diverse youth. J Marriage Fam. 1992;54(4):749–62.

    Article  Google Scholar 

  35. Geda YF. Determinants of teenage pregnancy in Ethiopia: a Case–control study, 2019. Curr Med Issues. 2019;17(4):112.

    Article  Google Scholar 

  36. Mandiwa C, Namondwe B, Makwinja A, Zamawe C. Factors associated with contraceptive use among young women in Malawi: analysis of the 2015–16 Malawi demographic and health survey data. Contracept Reprod Med. 2018;3:12.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Nyarko SH. Prevalence and correlates of contraceptive use among female adolescents in Ghana. BMC Womens Health. 2015;15:60.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Silk J, Romero D. The role of parents and families in teen pregnancy prevention: an analysis of programs and policies. J Fam Issues. 2014;35(10):1339–62.

    Article  Google Scholar 

  39. Sidze EM, Elungata’a P, Maina BW, Mutua MM. Does the quality of parent–child connectedness matter for adolescents’ sexual behaviors in Nairobi informal settlements? Arch Sex Behav. 2015;44:631–8.

    Article  PubMed  Google Scholar 

  40. Wamoyi J, Fenwick A, Urassa M, Zaba B, Stones W. Parent-child communication about sexual and reproductive health in rural Tanzania: Implications for young people’s sexual health interventions. Reprod Health. 2010;7(1):1–18.

    Article  Google Scholar 

  41. Ochen AM, Chi PC, Lawoko S. Predictors of teenage pregnancy among girls aged 13–19 years in Uganda: a community based case-control study. BMC Pregnancy Childbirth. 2019;19(1):211.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Updegraff KA, McHale SM, Crouter AC, Kupanoff K. Parents’ involvement in adolescents’ peer relationships: a comparison of mothers’ and fathers’ roles. J Marriage Fam. 2001;63(3):655–68.

    Article  Google Scholar 

  43. Kreager DA, Staff J, Gauthier R, Lefkowitz ES, Feinberg ME. The double standard at sexual debut: Gender, sexual behavior and adolescent peer acceptance. Sex Roles. 2016;75:377–92.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Whitehead E. Understanding the association between teenage pregnancy and inter-generational factors: a comparative and analytical study. Midwifery. 2009;25(2):147–54.

    Article  PubMed  Google Scholar 

  45. Gage AJ. Sexual activity and contraceptive use: the components of the decisionmaking process. Stud Fam Plann. 1998;29(2):154–66.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

No funding.

Author information

Authors and Affiliations

  1. College of Health and Medical Sciences, Dire Dawa University, Dire Dawa, Ethiopia

    Mawerdi Adem

  2. College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia

    Saba Hailu, Nega Assefa & Tesfaye Assebe Yadeta

Authors
  1. Mawerdi Adem
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Saba Hailu
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Nega Assefa
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Tesfaye Assebe Yadeta
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

M.A. had carried out the overall design and execution of the study, performed data collection and statistical analysis. N.A and T.A. have critically revised the design of the study, data collection techniques, and helped with the statistical techniques. S.H. participated in the statistical analysis and drafted the manuscript. All authors reviewed the manuscript and finally approved it for submission.

Corresponding author

Correspondence to Saba Hailu.

Ethics declarations

Ethics approval and consent to participate

The study was conducted following the declaration of Helsinki where ethical clearance was obtained from the Institutional Health Research Ethics Review Committee (IHRERC) of Haramaya University College of Health and Medical Sciences. An official letter was given to the Dire Dawa education bureau and a letter was sent to sample selected schools before data collection was started. Informed, voluntary written and signed consent was obtained from each participant who were 18 years old and above. For minors (less than 18 years of age) informed, voluntary written and signed consent was obtained and given to selected students to sign their family or guardians and asked them to bring on the next day then the data were collected. Confidentiality of the study participant’s information was ensured throughout data collection.

Consent for publication

Study participants/guardians agreed publication of aggregate data.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Adem, M., Hailu, S., Assefa, N. et al. From peer influence to parental roles: factors associated with teenage pregnancy in Dire Dawa city, Eastern Ethiopia. Reprod Health 22, 63 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12978-025-02014-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12978-025-02014-0

Keywords

Reproductive Health

ISSN: 1742-4755