Spatial distribution of pregnancy and early motherhood among late adolescent girls in Ethiopia using data from the Ethiopia Demographics and Health Survey 2019: Spatial and multilevel analyses.

Background: Various governmental and non-governmental organizations in Ethiopia are striving to decrease adolescent pregnancy by enacting laws against early marriage, developing a national youth and adolescent reproductive health strategy, legalizing abortion, and developing an HIV/AIDS policy for youth; however, the issue of teenage pregnancy& early motherhood remains a major concern.

Methods: Data were obtained from the Ethiopian Demographics and Health Survey (EDHS) in 2019. A total sample of 2210 adolescents was included in our study. Spatial autocorrelation, hotspot analysis, and spatial interpolation were used to observe significant spatial variation and clustering and to predict the prevalence of pregnancy in an unsampled area among adolescent girls in Ethiopia; a multilevel binary logistic regression model was fitted to identify factors associated with the outcome variable. The adjusted odds ratio was calculated with a 95% confidence interval, and the variables with a p-value 0.05 in the multivariable multilevel logistic regression were determined to be statistically significant.

Results: Global spatial autocorrelation analyses showed that the spatial distribution of late-adolescent pregnancy and early motherhood varied across Ethiopia (the Global Moran's Index I value showed GMI = 0.014, P 0.001). The spatial distribution revealed a high cluster (hot spot) of late-adolescent pregnancy and early motherhood in most parts of Gambella, Afar, Benishangul-Gumuz, the eastern part of Oromia, and Somalia. In the multivariable multilevel analysis, being 17 years old (AOR = 3.43; 95% CI: 1.54-7.59), 18 years old (AOR = 14.92; 95% CI: 6.78-32.8), and 19 years old (AOR = 8.44; 95% CI: 4.06, 17.56), married (AOR = 25.38; 95% CI: 15.33, 42.02), having completed primary, secondary, and higher education (AOR = 0.45; 95% CI: 0.21-0.95), and being at Gambela (AOR = 3.64; 95% CI: 1.04, 12.75) were significant predictors of late adolescent pregnancy and early motherhood.

Conclusion: Overall, the prevalence of late-adolescent pregnancy and early motherhood was found to be high. At the individual level, marital status, educational attainment, and age of adolescents were significant predictors of pregnancy and early motherhood, and regions were found at a community level associated with pregnancy and early motherhood among late adolescents. Therefore, late-adolescent girls should be educated about menstruation, sexual intercourse, pregnancy, and contraceptives before they reach early adolescence.