Pregnancy and marriage among teenage schoolgirls in rural western Kenya; a secondary analysis of a menstrual solution feasibility COHORT study

Background: Adolescent pregnancy increases the risk of adverse health outcomes, social stigma, loss of education and employment, and early marriage. Research characterising at risk girls will inform targeting of effective interventions.Methods: Risk characteristics for adolescent pregnancy were evaluated in schoolgirls aged 14-16 years as a secondary analysis in a longitudinal study evaluating menstrual products in 30 primary schools in rural western Kenya. Characteristics of participants were collected at baseline and follow-up. Descriptive and multivariate analysis were conducted.Results: Of 766 girls enrolled into the study, aged 14-16 years and followed over a school year, 53 (7%) were or became pregnant, with three (6%) neonatal deaths reported. Girls with the lowest compared with the highest socio-economic status had 2.5-fold higher risk of pregnancy (13.1% vs 5.0%: adjusted risk ratio (aRR) 2.48, confidence limits 1.32-4.64). Girls reporting early menarche (<13 years) had a 2.5-fold higher risk of pregnancy (aRR 2.61, 1.38-4.92), while those happy in school had a reduced risk (aRR 0.60, 0.34-1.04). Age, presence of parents, and being harassed by boys or men were not associated with pregnancy risk. Twenty-two girls (2.9%) married by the study end. Marriage was significantly associated with pregnancy (aRR 13.44, 5.50-32.83) and a history of sex at baseline (3.15, 1.55-6.38). All but two girls dropped out of school when pregnant with only five girls returning after delivery.Conclusions:Pregnancy leading to school dropout and child marriage remains an urgent public health concern among teenage girls in rural Kenya. Interventions are needed to enable schoolgirls to reach their educational potential.