Factors associated with adolescent pregnancy in Nyarugenge and Burera districts, Rwanda

Adolescent pregnancy remains a pressing global public health concern, with 21 million births annually among 15–19-year-old girls, 12 million of which occur in low- and middle-income countries. Sub-Saharan Africa (SSA) experiences disproportionately high adolescent birth rates, driven by poverty, cultural norms, gender inequality, and limited access to sexual and reproductive health and rights (SRHR) services. In Rwanda, despite significant progress in reproductive health, adolescent pregnancy remains prevalent, affecting 5% of girls aged 15–19, with regional disparities. Existing studies highlight contributing factors, including socioeconomic status, limited SRHR services, and cultural stigmas, but gaps persist in understanding comprehensive determinants and adolescent experiences. A cross-sectional survey was conducted in Burera (rural) and Nyarugenge (urban) districts in Rwanda to understand factors influencing adolescent pregnancy. A total of 441 adolescent girls aged 12–19 years (253 from Burera and 188 from Nyarugenge) were recruited using systematic random sampling. Data collection occurred between June and August 2024, with questionnaires administered in Kinyarwanda by trained research assistants. Descriptive statistics and logistic regression analyses were used to identify associations between adolescent pregnancy and socio-demographic and SRHR factors. The study revealed a 12.7% prevalence of adolescent pregnancy, with significant regional disparities: 80.4% of cases occurred in rural Burera, compared to 19.6% in urban Nyarugenge. Adolescents aged 15–19 years had reduced odds of pregnancy compared to their younger peers aged 12–14 years, though this difference was not statistically significant. Secondary education emerged as a protective factor, significantly lowering the odds of pregnancy (OR = 0.13, p = 0.017). Delaying sexual debut to ages 15–17 was also strongly protective (OR = 0.04, p < 0.001). Formal sexual and reproductive health education was associated with reduced pregnancy risk, reported by 67.8% of non-pregnant adolescents compared to 33.9% of pregnant adolescents (OR = 0.29, p = 0.012). Socio-economic stability, reflected by maternal employment and parental education, further reduced pregnancy risk. Rural adolescents faced greater barriers to accessing SRHR services, including confidentiality concerns (55.4% vs. 35.6%, p = 0.004) and limited service availability (12.5% vs. 1.8%, p = 0.017), highlighting the challenges in addressing adolescent pregnancy in rural settings. Addressing adolescent pregnancy in Rwanda requires targeted interventions focusing on rural areas like Burera, where pregnancy rates are highest. Expanding access to SRHR education, improving service delivery, and addressing socio-economic barriers are critical steps in reducing pregnancy rates and promoting adolescent health. Collaborative efforts should prioritize enhancing educational opportunities, empowering parents, and improving adolescents’ awareness and confidence in accessing reproductive health services.