Barriers and Enablers of Adolescent Sexual and Reproductive Health Outcomes: A Case-Control Study in Rwanda

Abstract

<title>Abstract</title> <bold>Background</bold>Teenage pregnancy remains a global health concern, with Rwanda experiencing an increase due to limited contraception knowledge, economic constraints, family conflicts, and limited access to healthcare, despite efforts to promote girls' education.<bold>Methods</bold>This study examined risk factors for teenage pregnancy among adolescents aged 15 to 19 using a case-control design in high-prevalence districts. Teen mothers and pregnant adolescents were compared with their non-pregnant peers. Statistical analyses, including conditional multivariable logistic regression, identified significant risk factors.<bold>Results</bold>The median age of participants was 18 years (IQR = 1.0), with 46.3% aged 18. Pregnant adolescents were more likely to have incomplete primary education (40.7% vs. 19.5%) and be currently studying (83.3% vs. 49.1%) than their non-pregnant counterparts. Protective factors included health facility visits for sexual and reproductive health (SRH) services (AOR = 0.16, 95%CI: 0.07–0.41, <italic>p</italic> &lt; 0.001), and comfort in asking parents ASRH questions (AOR = 0.33, 95%CI: 0.11–0.95, p = 0.039). In contrast, not being enrolled in school (AOR = 8.22, 95%CI: 2.98–22.69, <italic>p</italic> &lt; 0.001) significantly increased the likelihood of pregnancy.<bold>Conclusion</bold>The rising rates of teenage pregnancy in Rwanda highlight the urgent need for policies supporting school retention and comprehensive SRH education. Strengthening parental communication, expanding adolescent-friendly SRH services, and implementing community-based interventions are essential in addressing teenage pregnancy. Additionally, psychosocial support and economic empowerment programs for young mothers can mitigate their long-term impacts.