Teenage pregnancy in KwaZulu-Natal Province, South Africa: An 8-year trend analysis (2017/18 - 2024/25)

Background. Pregnancy remains a major public health concern among young people in South Africa, particularly in KwaZulu- Natal Province (KZN), where high teenage fertility intersects with poverty, gender-based violence and limited access to reproductive health services. Objectives. This study analyses trends in teenage pregnancies in KZN from 2017/18 to 2024/25, disaggregated by age group (10 - 14 and 15 - 19 years) and district, to identify temporal patterns, geographical disparities and vulnerable populations. Methods. Quantitative secondary analysis was conducted using routine health facility data from the District Health Information System (webDHIS). Descriptive statistics and age-specific delivery rates per 1 000 adolescent girls were calculated to assess provincial trends and district-level variation. Results. Teenage deliveries increased from 32 502 in 2017/18 to a peak of 36 460 in 2019/20 (53.2 per 1 000), before declining to 29 794 in 2024/25 (42.8 per 1 000). Older teenagers (aged 15 - 19 years) accounted for >97% of deliveries, with rates declining from 51.7 per 1 000 in 2019/20 to 42.0 per 1 000 in 2024/25. Very young teenagers (aged 10 - 14 years) contributed fewer deliveries (530 - 993 annually), but with persistently high rates in rural districts such as Zululand, uMkhanyakude and King Cetshwayo (≥2 per 1 000). Population-adjusted comparisons showed that eThekwini had fewer deliveries than expected (–8.1 percentage points), while rural districts exceeded expectations (2.8 - 4.4 percentage points). Conclusion. Teenage pregnancies in KZN remain unevenly distributed, with rural and peri-urban districts disproportionately affected, and very young teenagers particularly vulnerable. Addressing these disparities requires interventions that target structural drivers, strengthen child protection systems, expand teenage-friendly reproductive health services and engage boys and young men in prevention efforts.