School-level factors accounting for pregnancy rates among adolescent girls in Kenya Secondary schools

Abstract Background Adolescent pregnancy remains a critical public health challenge to education and health outcomes in Kenya. The rate of in-school adolescent girls getting pregnant has been of great concern, creating the need to understand the contributing factors. While individual and home factors have been investigated, little focus has been on school-level factors accounting for pregnancy cases. Thus, we sought to establish the prevalence and school-level factors of adolescent girls’ pregnancies. Methods This was a cross-sectional survey conducted in 1008 secondary schools randomly sampled to represent different school types and geographies. The head teachers were interviewed on school attributes, including health infrastructure and services. We used descriptive statistics and linear regression to assess factors associated with cases of pregnancy in schools. Results The median adolescent pregnancy rate in schools was 1.3% (IQR: 0.03-3.1). From linear regression model, being in a private school [coef -0.008, 95%CI: -0.015, -0.002], increasing number of years the school principal has been in school management [coef -0.001, 95%CI: -0.001, -0.0001], providing changing rooms for girls in school [coef -0.007, 95%CI: -0.011, -0.0023], and school providing counselling services [coef -0.010, 95%CI: -0.015, -0.006] were protective against schools reporting adolescent pregnancies. Conversely, school being a mixed boys and girls [coef 0.010, 95%CI: 0.005, 0.016] and sending away learners for school fees [coef 0.007, 95%CI: 0.002, 0.012] increased the risk of schools reporting adolescent pregnancies. Conclusions We identified actionable school-based determinants of school pregnancy cases that underscore the role of the school environment in either mitigating or exacerbating risks of adolescent pregnancy. Thus, we provide evidence for education and health policymakers to integrate structural interventions within schools as part of broader adolescent reproductive health strategies. Key messages • We make a significant contribution to the existing body of knowledge by shifting the focus from individual and household-level determinants of adolescent pregnancy to school-level. • We provide evidence for education and health policymakers to integrate structural interventions within schools as part of broader adolescent reproductive health strategies.