A decade of teenage pregnancy in South Africa, 2014–2023: A spatial analysis of national birth records

Teenage pregnancy remains a significant and multifaceted public health concern within the South African context. This public health threat has led to a disproportionate prevalence of HIV among female youth, along with increased maternal and child mortality rates. This retrospective cohort study employed birth record data from South Africa. This study utilises descriptive statistics and the Pearson Chi-Square Test of Independence to analyse the statistical differences in the prevalence of teenage pregnancy. The Global Moran’s I was employed to analyse spatial autocorrelation, and the Local Moran’s I was subsequently utilised to identify hotspots of teenage pregnancy. In the past decade, births to mothers under the age of 20 constituted 13.0% of a total of 9,609,356 births, amounting to 1,249,074 births. Teenage pregnancy rates were markedly elevated from 2014 to 2018 in comparison to the period from 2019 to 2023 (13.7% versus 12.3%, p<0.001). Late registration of teenage births occurred at a significantly higher rate (34.8%, p<0.001). The Global Moran’s I value of 0.5641 (z-score=6.29; p<0.001) demonstrates a strong and statistically significant positive spatial autocorrelation. The Local Moran’s I identified two significant High-High clusters extending from northern KwaZulu-Natal into the Eastern Cape. This study's findings highlight the necessity for a focused intervention to tackle teenage pregnancy in the Eastern Cape and KwaZulu-Natal, concentrating on the identified hotspots. Interventions should prioritise comprehensive sex education for youth and enhance access to contraception and family planning services. District-level health departments can utilise these findings to identify and prioritise high-risk areas. Spatial insights should guide local planning, particularly regarding outreach and mobile health services.