DETERMINANTS OF TEENAGE PREGNANCIES AMONG

SECONDARY SCHOOL GIRLS: A CASE STUDY OF SELECTED

SCHOOLS IN KALINGALINGA COMPOUNND IN LUSAKA
DISTRICT.

By:

1. SUSAN LUPUTA …………………….300651

2. TINA NAYAME………………………...300619
3. DELPHINE SHILUMAMBA……………300620
4. LINDA NDLOVU…………………………300626
5. DOREEN KAILI………………………….300699
6. ANISHA MUFOMI……………………….300518

A research proposal submitted in partial fulfilment for the award of the diploma in
registered Midwifery at Gideon Robert University
TABLE OF CONTENTS
Content Page No.
Operational definitions
Abbreviations and Acronyms
List of tables
List of figures
Chapter One: Introduction
1.0 Introduction
1.1 Background Information
1.2 Statement of the Problem
1.3 Aim of the Study
1.4 Objectives of the study
1.4.1 General Objective
1.4.2 Specific Objectives
1.5 Research Questions
1.6 Theoretical/Conceptual Framework
1.6.0 Theoretical Framework
1.6.1 The Health Belief Model
1.6.2 Conceptual Framework
1.7 Significance of the study
1.8 Variables
1.8.1 Dependent Variable
1.8.2 Independent Variables

OPERATIONAL DEFINITIONS
Adolescent: any person between ages 10 and 19.This age range falls within World Health
Organization’s definition of young people, which refers to individuals between ages 10-24.
The terms adolescents, young people and youths are used interchangeably.

Prevalence: The proportion of persons in a population who are infected with a disease
at a specific point in time.

Sexually Active: Refers to the capability of having sexual relations.

Unprotected Sex: Having coitus with maximum contact between male and female
genitals without any barrier.

Risky Sexual Behavior: Activities in relation to sex that may lead to contracting
STIs/HIV/AIDS, as well as conception of unplanned pregnancy.

Peer Pressure: Is a feeling that one must do things as other people of one’s age and
social group in order to be liked by them.

Knowledge: Facts, information, and skills acquired through experience or

education

Counselling: The process of giving advice or providing information on

STIs/HIV/AIDS, or any sexual reproductive health issues.

Predisposing factors: Are intellectual and emotional “givens” that tend to make individuals
more or less likely to adopt healthful or risky behaviors or lifestyles or to approve of or
accept particular environmental conditions. Some of these factors can often be influenced by
educational interventions. They include knowledge, attitudes, beliefs and values

Enabling factors: Are those internal and external conditions directly related to the issue that
help people adopt and maintain healthy or unhealthy behaviors and lifestyles, or to embrace
or reject particular environmental conditions. They include availability and accessibility of
resources/services.

Reinforcing factors: Are the people and community attitudes that support or make difficult
adopting healthy behaviors or fostering healthy environmental conditions. These are largely
the attitudes of influential people: family, peers, teachers, employers, health or human service
providers, the media, community leaders, and politicians and other decision makers. An
intervention might aim at these people and groups – because of their influence – in order to
most effectively reach the real target group.

Independent variable:

Dependent variable:
ABBREVIATIONS AND ACRONYMS

ADH Adolescent Health

AIDS Acquired Immune Deficiency Syndrome
CDC Centers for Disease Control and Prevention
CSO Central Statistical Office
GRZ Government of the Republic of Zambia
HIV Human Immunodeficiency Virus
MDGs Millennium Development Goals
MoE Ministry of Education
MoH Ministry of Health
NGO Non-Governmental Organisation
SRH Sexual and Reproductive Health
STIs Sexually Transmitted Infections
UNAIDS Joint United Nations Program on HIV/AIDS
UNICEF United Nations Children’s Fund
WHO World Health Organization
ZAACW Zambia Association of Child Care Workers
ZAMPHIA Zambia Population-based HIV Impact Assessment
ZDHS Zambia Demographic Health Survey
ZSA Zambia Statistics Agency
1.0 Introduction
Nearly 30% of adolescent girls in Zambia become pregnant by the age of 18 according to the
Zambia Demographic Health Survey (ZDHS 2018). This high rate of teenage pregnancy
remains a significant concern and possesses major development challenges. When adolescent
girls fall pregnant, they drop out of school, this reduces the opportunities to actualize their
full potential and entangles them in a perpetual circle of poverty and inequality.

Every year, an estimated 21 million girls aged 15–19 years in developing regions become
pregnant and approximately 12 million of them give birth. At least 777,000 births occur to
adolescent girls younger than 15 years in developing countries.

The estimated global adolescent-specific fertility rate has declined by 11.6% over the past 20
years. There are, however, big differences in rates across the regions. The adolescent fertility
rate in East Asia, for example, is 7.1 whereas the corresponding rate in Central Africa is
129.5.

Adolescent pregnancies are a global problem occurring in high-, middle-, and low-income
countries. Around the world, however, adolescent pregnancies are more likely to occur in
marginalized communities, commonly driven by poverty and lack of education and
employment opportunities.

Several factors contribute to adolescent pregnancies and births. In many societies, girls are
under pressure to marry and bear children early. In least developed countries, at least 39% of
girls marry before they are 18 years of age and 12% before the age of 15. In many places girls
choose to become pregnant because they have limited educational and employment prospects.
Often, in such societies, motherhood is valued and marriage or union and childbearing may
be the best of the limited options available.

Adolescents who may want to avoid pregnancies may not be able to do so due to knowledge
gaps and misconceptions on where to obtain contraceptive methods and how to use
them. Adolescents face barriers to accessing contraception including restrictive laws and
policies regarding provision of contraceptive based on age or marital status, health worker
bias and/or lack of willingness to acknowledge adolescents’ sexual health needs, and
adolescents’ own inability to access contraceptives because of knowledge, transportation, and
financial constraints. Additionally, adolescents may lack the agency or autonomy to ensure
the correct and consistent use of a contraceptive method. At least 10 million unintended
pregnancies occur each year among adolescent girls aged 15-19 years in developing regions.

An additional cause of unintended pregnancy is sexual violence, which is widespread with

more than a third of girls in some countries reporting that their first sexual encounter was
coerced.

1.1 Background to the study

Globally, adolescents represent a major demographic and socio-economic force, and are also
a major factor in influencing public health trends. Currently, adolescents are estimated at one
fifth (or 20%) of the world’s population and form a major proportion of the socially,
economically and sexually active population. Eighty-eight percent (88%) of the world’s
adolescents live in developing countries, and Sub-Saharan Africa (State of the World’s
Children 2021 Report, UNICEF).

Adolescents are defined as young people between the ages of 10 and 19 years. Zambia
recognizes the importance and significant impact that adolescents have on the overall health
status of the country, including the attainment of the national health objectives and
Millennium
Development Goals (MDGs). In view of the foregoing, the Ministry of Health (MoH) has
identified the need to strengthen Adolescent Health (ADH), by developing and implementing
a national strategy, aimed at providing a comprehensive and coordinated response to ADH
problems and needs in the country.

Africa is home to 18% of these adolescents. Due to the major biological and psychological
transformations associated with this age group, adolescents are significantly exposed to risky
behaviours, with high consequences on their immediate and long-term health and socio-
economic lives.

In Zambia, adolescents account for over a quarter (approximately 27%) of the total
population. Whilst the importance of this age group has been acknowledged in various
national policy documents such as the National Population Policy of 2019 and the National
Youth Policy of 2015, the health of this population group has not been given the special
attention that it deserves. Further, a number of surveys have provided evidence of continued
high prevalence of health risk behaviours among the adolescents and young adults. This
situation was confirmed in the Adolescent Health Strategic Plan 2017-2021, which reviewed
the status of ADH in Zambia.

In view of this background, MOH has identified the need to develop and implement the
ADH-SP 2017-2021, in order to provide for an appropriate strategic framework for a
comprehensive and coordinated national response to adolescent health needs.

In Zambia teenage sexuality like in other developing countries is of concern. Zambia

Association of Child Care Workers (ZAACW) newsletter (2017) indicated that, over 30% of
15-19 year old girls have already been pregnant or have had a child, which is an alarming rate
among adolescents. Teenagers give birth at a tender age when their bodies are not ready. This
is due to many challenges they face which include access to Sexual and Reproductive Health
(SRH) information and services, unfriendly health services, and negative influence from the
media. Other factors are transactional sex, early marriages, child abuse, peer pressure,
negative socio-cultural norms and practices and poverty

In Africa, particularly the Sub-Saharan Africa, the birth control practice is not as effective as
that of the U.S.A (Stanley, 2017). The Sub-Saharan region has the highest rate of pregnancies
with 143 pregnancies per 1000 teenagers. The highest rate of teenage pregnancy in Sub-
Saharan Africa can be attributed to a large number of women who tend to marry at an early
age. In West African region, Niger has the highest rate of teen pregnancies at 133 per 1000
teens. In Niger, for example, 53% of women give birth to a child before the age of 18. This is
higher than the average pregnancy rate for the sub region.

In Zambia, 33.5 % of girls are married before age of 18, and adolescent pregnancy rate is as
high as 290 births/1,000 women (ZDHS, 2018). The number of pregnancies among teenagers
has been rising in Zambia over the past years. In 2002 there were 3,663 teenage pregnancies
among school going teenagers; in 2004, the number rose to 6,528; in 2014 the figure had
risen further to 11,391 and to 13,634 in 2018 (Annual Education Statistical Bulletin, Lusaka,
2019).

By 2020, the Ministry of Education reported that there were over 15,000 teenage pregnancies
among school going teenagers in Zambia. Despite the trend revealed by these statistics,
discussion of subjects such as sexual health, sexuality and HIV are still regarded as
inappropriate in many areas of the country, especially in rural and densely populated
communities (Annual School Census, 2020)

1.2 Statement of the problem

Teenage pregnancy is a growing concern in Zambia. Teenagers get unwanted pregnancies
while others get married before they are biologically mature. In an ideal situation, teenagers
are expected to be in school during their teenage years, as they are building their future.
Given that some researches on factors associated with teenage pregnancy have been done in
schools and several campaigns against teenage pregnancy have also been conducted, the
prevalence of teenage pregnancy is still high in Zambia. According to ZDHS (2018), about
three in ten young women aged 15-19 have begun childbearing, that is, they have given birth
already or are currently pregnant with their first child. Teenage pregnancies and deliveries
often involve complications and greater risk of maternal mortality and morbidity, as
compared to pregnancies of women in their twenties (WHO, 2018). Furthermore, Warenius
(2018) states that this has been a major cause of school drop-outs of young pregnant girls in
order to avoid social stigma; while others have resorted to induced abortions which is often
accompanied by devastating consequences. The need to reduce teenage pregnancy is
necessary because it is associated with poor socio-demographic outcomes such as high
fertility, high mortality and teenage motherhood.

It is with this background that this study is aimed at establishing factors associated with
teenage pregnancy in Zambia using evidence from the 2018 Zambia Demographic and Health
Survey (ZDHS) data as it represents teenagers at the national level.

1.3 Aim of the study

The aim of the study is to determine factors associated with teenage pregnancies in
Kalingalinga compound of Lusaka district.

According to ZDHS (2018), about three in ten young women aged 15-19 have begun
childbearing, that is, they have given birth already or are currently pregnant with their first
child. Despite teenage pregnancy being the major cause of school drop-outs for young
pregnant girls, it poses health risks for both mothers and children. The need to reduce teenage
pregnancy is necessary because it is associated with poor socio-demographic outcomes such
as high fertility, high mortality and teenage motherhood.

It is with this view that results obtained from this study may enhance knowledge on factors
associated with teenage pregnancy and motherhood. In an ideal situation teenagers in this age
group are not supposed to become pregnant or married but on the ground there are being
pregnant or married. The gaps in information on all aspects of teenage pregnancy will need to
be filled so that the data must inform policy and program makers and provide a basis for an
effective advocacy on the matter. In addition, teenagers in Zambia need close attention; the
study will help program planners and policy makers in schools and health care facilities
creating programs aimed at reducing teenage pregnancy. This may further contribute to the
promotion of gender equality and empowering of women through seeking to eliminate gender
disparity in primary and secondary education and improve ratios of females to males in
tertiary education.

1.4 Objectives of the study

1.4.1 General objective
To determine factors associated with teenage pregnancies in Kalingalinga compound of
Lusaka district.
1.4.2 Specific Objectives
1. To determine the prevalence of teenage pregnancies in Kalingalinga compound
2. To determine factors influencing teenage pregnancies in Kalingalinga compound.
3. To determine the availability of SRH services in Kalingalinga compound.

1.5 Research questions

1. What is the prevalence of teenage pregnancies in Kalingalinga compound?
2. What are factors influencing teenage pregnancies in Kalingalinga compound?
3. Are SRH services available in Kalingalinga compound?

1.6 Theoretical/Conceptual Framework

1.6.0 Theoretical Framework

In this study, the Health Belief Model will be used as theoretical framework as it depicts how
individuals view health related problems and how they utilize health services based on their
perceptions. The mode looks at health behaviours regarding the uptake of health services.
1.6.1 The Health Belief Model

The health belief model is a psychological health behaviour change model developed to
explain and predict health-related behaviours, particularly in regard to the uptake of health
services. The health belief model was developed in the 1950s by social psychologists namely
Hochbaum, Rosenstock and Kegels working at the United States Public Health Services and
it still remains one of the most well-known and widely used theories in health behaviour
research. The health belief model suggests that people’s beliefs about health problems,
perceived benefits of action, barriers to action and self-efficacy explain engagement (or lack
of engagement) in health-promoting behaviour. A stimulus or cue to action must be present in
order to trigger the health promoting behaviour. This model in our study fits on the area of
health education regarding prevention of pregnancy and how an individual utilizes the health
services depending on how they perceive the problem to be.

The following constructs of the health belief model are proposed to vary between individuals
and predict engagement in health-related behaviours (e.g. using family planning methods or
abstain from sexual intercourse)

1.6.1.1 Perceived Severity

Perceived severity refers to subjective assessment of the severity of a health problem and its
potential consequences. The health belief model proposes that individuals who perceive a
given health problem as serious are more likely to engage in behaviours to prevent the health
problem from occurring (or reduce its severity). Perceived seriousness encompasses beliefs
about the disease itself (e.g. whether it is life threatening or may cause disability or pain) as
well as broader impacts of the disease on functioning in work and social roles.

A person who perceives that engaging in unprotected sexual intercourse can result into
pregnancy and other diseases would find means of avoiding that. If one considers the
seriousness of the complications of getting pregnant and their outcomes, they would not
engage in practices that could expose them to getting pregnant. It could be that this person
would use protective means or completely abstain from sexual intercourse. One can be
compounded with fear and would try to avoid becoming pregnant.
1.6.1.2 Perceived Susceptibility

Perceived susceptibility refers to subjective assessment of risk of developing a health

problem. The health belief model predicts that individuals who perceive that they are
susceptible to a particular health problem will engage in behaviours to reduce their risk of
developing the health problem. Individuals with low perceived susceptibility may deny that
they are at risk for contracting a particular illness. Others may acknowledge the possibility
that they could develop the illness, but believe it is unlikely. Individuals who believe they are
at low risk of developing an illness are more likely to engage in unhealthy, or risky,
behaviours. Individuals who perceive a high risk that they will be personally affected by a
particular health problem are more likely to engage in behaviours to decrease their risk of
developing the condition.

An adolescent who feels they are at risk or susceptible of falling pregnant would use
measures to prevent that from occurring. Such an adolescent would use either condoms or
would refrain from having unprotected sexual intercourse. .

The combination of perceived seriousness and perceived susceptibility is referred to as

perceived threat. Perceived seriousness and perceived susceptibility to a given health
condition depend on knowledge about the condition. The health belief model predicts that
higher perceived threat leads to higher likelihood of engagement in health-promoting
behaviours.

1.6.1.3 Perceived Benefits

Health-related behaviours are also influenced by the perceived benefits of taking action.
Perceived benefits refer to an individual's assessment of the value or efficacy of engaging in a
health-promoting behaviour to decrease risk of disease. If an individual believes that a
particular action will reduce susceptibility to a health problem or decrease its seriousness,
then he or she is likely to engage in that behaviour regardless of objective facts regarding the
effectiveness of the action. For example, individuals who believe that using condoms prevents
pregnancy are more likely to use condoms than individuals who believe that using condoms
will not prevent the occurrence of pregnancy.
When one feels that not falling pregnant has more advantages than getting pregnant would
not get pregnant. She would ensure that she uses means of preventing becoming pregnant
with a view of either continuing with education or finding a better paying job.

1.6.1.4 Perceived Barriers

Health-related behaviours are also a function of perceived barriers to taking action. Perceived
barriers refer to an individual's assessment of the obstacles to behaviour change. Even if an
individual perceives a health condition as threatening and believes that a particular action will
effectively reduce the threat, barriers may prevent engagement in the health-promoting
behaviour. In other words, the perceived benefits must outweigh the perceived barriers in
order for behaviour change to occur. Perceived barriers to taking action include the perceived
inconvenience, expense, danger (e.g., side effects of a medical procedure) and discomfort
(e.g., pain, emotional upset) involved in engaging in the behaviour.

If one feels that there are barriers to engage in the prevention of pregnancy she would not
take up that action. For instance, if she feels that there are friends or relatives at the place of
accessing the family planning methods she would not go there. Also if she feels that the
providers of the service might label her as a prostitute, she would not access the service.

1.6.1.5 Modifying Variables

Individual characteristics, including demographic, psychosocial, and structural variables, can

affect perceptions (i.e., perceived seriousness, susceptibility, benefits, and barriers) of health-
related behaviours. Demographic variables include age, sex, race, ethnicity, and education,
among others. Psychosocial variables include personality, social class, and peer and reference
group pressure, among others. Structural variables include knowledge about a given disease
and prior contact with the disease, among other factors. The health belief model suggests that
modifying variables affect health-related behaviours indirectly by affecting perceived
seriousness, susceptibility, benefits, and barriers.

1.6.1.6 Cues to Action

The health belief model posits that a cue, or trigger, is necessary for prompting engagement
in health-promoting behaviours. Cues to action can be internal or external. Physiological cues
(e.g., pain, symptoms) are an example of internal cues to action. External cues include events
or information from close others, the media, or health care providers promoting engagement
in 5health-related behaviours. Examples of cues to action include a reminder postcard from a
Nurse/Midwife, the illness of a friend or family member, and product health warning labels.
The intensity of cues needed to prompt action varies between individuals by perceived
susceptibility, seriousness, benefits, and barriers. For example, individuals who believe they
are at high risk for a serious illness and who have an established relationship with a primary
care doctor may be easily persuaded to get screened for the illness after seeing a public
service announcement, whereas individuals who believe they are at low risk for the same
illness and also do not have reliable access to health care may require more intense external
cues in order to get screened.

Girls who have seen the posters on the effects of pregnancy and have an access to medical
services would go for preventive care measures unlike those who do not know anything about
consequences of getting pregnant.

1.6.1.7 Self-Efficacy

Self-efficacy was added to the four components of the health belief model (i.e., perceived
susceptibility, seriousness, benefits, and barriers) in 1988. Self-efficacy refers to an
individual's perception of his or her competence to successfully perform a behaviour. Self-
efficacy was added to the health belief model in an attempt to better explain individual
differences in health behaviours.

An individual can have the family planning methods such as condoms or pills but if he does
not know how to use them, she would still fall pregnant. An individual would feel using these
methods when she is not married as being a prostitute so they would not be free to use them
while on the other hand others would be free to use them and ask their partners to use them
too
 Self-Efficacy Perceived Benefits vs. Perceived
Barriers
(for example,ability to use
condoms effectively) (for example, completing school vs.
non-access to SRH services)

Perceived Susceptibility, Perceived Threat Likelihood of health promoting

Perceived Severity behaviour
(for example, getting pregnant
(for example, dying while giving while at school)
birth, engaging in sexual activity
without protective measures)

Cues to Action

(for example, pain during child

birth & complications associated
with pregnancy)

Figure 1.The Health Belief Model

1.6.2 Conceptual Framework

An important tool in visualizing the research problem is the conceptual framework.The

conceptual framework is used to limit the scope of the relevant data by focusing on specific
variables and defining the specific viewpoint [framework] that the researcher will take in
analysing and interpreting the data to be gathered. Figure 2 shows the conceptual framework
for the study.

SOCIODEMOGRAPHIC & NON ENABLING FACTORS

ECONOMIC FACTORS  Non-Availability, Non-
 Age Accessibility & Non-
 Sex Affordability of SRH
 Marital Status services
 Religion  Attitude of health
 Education personnel
 Occupation
 Residence
 Household Income

FACTORS LEADING TO
TEENAGE PREGNANCY

PREDISPOSING FACTORS REINFORCING FACTORS

 Knowledge  Family
 Beliefs  Peers
 Taboos  School Authorities
 Values  Community
 Attitudes  Religion


Figure 2. Conceptual Framework

1.7 Significance of the study
The results of this study will to a large extent show the factors associated with teenage
pregnancies in Kanyama compound. One of the known factors leading to teenage pregnancies
is the low or lack of uptake of SRH services by teenagers due to various reasons. Results
from the study will show whether these services are available and if teenagers are demanding
them.

The study will also inform policy makers and other stakeholders on areas that need concerted
efforts to address the problem of teenage pregnancies.

1.8 Variables
1.8.1 Dependent variable
Teenage pregnancy
1.8.2 Independent variables
Variables including age, religion, ethnic group, marital status, education level, occupational
status, monthly family income; and history of sexual and reproductive health, age at first
sexual intercourse, contraceptive use, age at marriage (early marriage), age at 1 st pregnancy,
planned pregnancy and perception on teenage pregnancy.
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