Marital status as a determinant of first adolescent pregnancy experiences, outcomes and consequences among adolescents in Mashonaland Central, Zimbabwe.

Adolescent pregnancy remains a critical public health and child protection challenge in Zimbabwe, with rural districts most affected. This study examined the association between marital status and first pregnancies and explored how marital status interacts with first pregnancy experiences, outcomes, and consequences, an area underexplored. A mixed-methods study was conducted in Mount Darwin district, integrating quantitative data from 309 adolescent girls aged 10-19 years with qualitative data. About 28% of the adolescent girls had ever been married, with 27% married and living with their partners, nearly 1% married but not living with their partners, and 6% divorced. The married respondents had higher SRHR knowledge (65% vs 47%, p<0.05) and modern contraceptive use (98% vs 72%, p<0.001) yet paradoxically higher pregnancy prevalence (93% vs 58%). There was high intention rate, 72% overall, rising to 80% among married/cohabiting adolescents versus 46% among single never-married (p=0.011). Married adolescents were more likely to report planned first pregnancies (62% vs 31%, p<0.001), less likely to initiate timely ANC (42% vs 58%, p=0.043), less likely to deliver in health facilities, and less likely to plan school re-entry (28% vs 76%, p<0.001). Married adolescents experienced more miscarriages (18%) and stillbirths (4%) versus none among unmarried peers, though unmarried adolescents faced higher obstetric complications (30% vs 16%, p=0.046). Postpartum family planning uptake was higher among married adolescents (98% vs 72%, p<0.001). Postnatal care attendance was high overall (92%), with lowest uptake among single never-married adolescents (86%) compared to married peers (92%). Unmarried pregnant adolescents experienced higher partner abandonment (91%), depression (58% vs 22%, p<0.001), and suicidal ideation (12% vs 3%, p=0.043). Marital status fundamentally shapes adolescent pregnancy outcomes. Married adolescents have better contraceptive access yet face barriers to ANC, facility delivery, and education. Unmarried adolescents experience severe partner abandonment, depression, and suicidal ideation. Differentiated interventions addressing marital status are essential.