AUTHOR=Namukisa Mary , Kamacooko Onesmus , Lunkuse Jane Frances , Ruzagira Eugene , Price Matt A. , Mayanja Yunia 

TITLE=Incidence of unintended pregnancy and associated factors among adolescent girls and young women at risk of HIV infection in Kampala, Uganda

JOURNAL=Frontiers in Reproductive Health

VOLUME=Volume 5 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2023.1089104

DOI=10.3389/frph.2023.1089104

ISSN=2673-3153

ABSTRACT=Background
In Sub-Saharan Africa, one in every five young women becomes pregnant and 50% of these are unintended. Pregnancies in adolescent girls and young women (AGYW) are associated with poorer maternal and neonatal outcomes, and a high abortion rate yet data are still limited on incident pregnancies among AGYW in vulnerable situations. We studied the incidence and factors associated with unintended pregnancy among AGYW who frequently engaged in transactional sex in Kampala, Uganda 

Methods
We analyzed data from a study that investigated uptake of oral pre-exposure prophylaxis among AGYW from January 2019 to December 2020. Volunteers attended 3-monthly study visits for 12 months each. Contraceptive services were provided to interested volunteers free of charge. Interviewers collected data on socio-demographics, sexual behavior, reproductive health outcomes and substance use. Pregnancy was determined by testing for Beta chorionic gonadotropin hormone in urine. The pregnancy incidence rate was estimated using the Kaplan-Meier technique and logistic regression used to determine the correlates of pregnancy.

Results
We included 285 volunteers with mean age of 19.9 [Standard deviation (SD), ±2.24] years; 54.7% had attained secondary school education or higher, 57.2% were single (never married), 92.6% reported engaging in transactional sex, 21.0% reported sex work as their main job, 51.9% consumed alcohol in the month prior to interview of whom 12.8% took alcohol daily, and 25.3% had Chlamydia trachomatis/Neisseria gonorrhea. The mean age at first sex was 15.7 (SD, ±2.1) years. We recorded 44 pregnancies over 187.2 person-years of follow up, an incidence of 23.5 per 100 person-years (95% CI 17.5–31.6). Incident pregnancies were more likely among volunteers who had ≥10 sexual partners in the past 3 months (aRR 1.97; 95% CI 1.05-3.70) and those who reported not using contraception (aRR 5.89; 95% CI 2.74-12.66). Incident pregnancies were less likely among those who reported alcohol consumption in the past month (aRR 0.52; 95% CI 0.30-0.90).

Conclusion
The incidence of unintended pregnancy was high despite availability of free contraceptive services. Sexual and reproductive health campaigns should strengthen demand creation and motivation to use contraception among young women with multiple sexual partners.