Predictors of unintended pregnancy among adolescent schoolgirls during the COVID-19-induced school closures: The case of rural and underserved communities in Ghana
In Ghana, unintended pregnancies account for one in three births and are associated with adverse maternal and child health outcomes—a problem that appears to have worsened during the COVID-19 lockdown and school closures. Hence, this study examines unintended pregnancy and its predictors among adolescent schoolgirls within the context of COVID-19-induced school closures in rural and underserved communities in Ejisu municipality in Ghana. The sample comprised 310 adolescent girls aged 13–19 years who had a pregnancy during the COVID-19 lockdown. Data were collected using a structured questionnaire, and both bivariate and multivariate regression techniques were used to analyze the data. Of the total respondents, 227 (73.2%) had unintended pregnancies during the COVID-19 lockdown. The majority, 234 (75.5%), were aged between 16 and 19 years, 275 (88.7%) lived in rural areas, and 126 (40.6%) lived with only their mothers. Regression results demonstrated that girls who lacked knowledge of contraception (crude odds ratio = 0.691, 95% confidence interval [CI] = [0.479, 0.581]) and sex education (crude odds ratio = 0.209, 95% CI = [0.121, 0.362]), had multiple sex partners (adjusted odds ratio = 1.382, 95% CI = [0.289, 0.921]), and lived with only their mothers during the COVID-19 lockdown were more likely to experience unintended pregnancy than their counterparts. Awareness of the predicting factors identified in this study can guide parental roles in reducing the likelihood of their children being lured sexually or victimized during disruptive occurrences like COVID-19-induced school closures.
Addae, E.A. (2021). COVID‐19 pandemic and adolescent health and well‐being in sub‐Saharan Africa: Who cares? The International Journal of Health Planning and Management, 36(1):219-222. https://doi.org/10.1002/hpm.3059
Agyapong, A., Ayentimi, D.T., & Sandow, J.N. (2024a). The impact of IT capability on the performance of SMEs in Ghana: The mediating role of business process agility. Technology Analysis and Strategic Management, 37(8):1-16. https://doi.org/10.1080/09537325.2024.2322022
Agyapong, A., Ayentimi, D.T., & Sandow, J.N. (2024b). Organisational creativity on product innovation performance of SMEs: Exploring mechanisms and boundary conditions. Innovation, 27(3):1-21. https://doi.org/10.1080/14479338.2024.2389898
Ajayi, A.I., Odunga, S.A., Oduor, C., Ouedraogo, R., Ushie, B.A., & Wado, Y D. (2021). “I was tricked”: Understanding reasons for unintended pregnancy among sexually active adolescent girls. Reproductive Health, 18:19. https://doi.org/10.1186/s12978-021-01078-y
Ames, H., Glenton, C., & Lewin, S. (2019). Purposive sampling in a qualitative evidence synthesis: A worked example from a synthesis on parental perceptions of vaccination communication. BMC Medical Research Methodology, 19:26. https://doi.org/10.1186/s12874-019-0665-4
Ameyaw, E.K., Budu, E., Sambah, F., Baatiema, L., Appiah, F., Seidu, A.A., et al. (2019). Prevalence and determinants of unintended pregnancy in sub-Saharan Africa: A multi-country analysis of demographic and health surveys. PloS One, 14(8):e0220970. https://doi.org/10.1371/journal.pone.0220970
Amoah-Saah, I., & Akosah, J.C. (2024). Teenage pregnancy among senior high school students in Ghana: Causes, effects and prevention. International Journal of Research and Innovation in Social Science, 8(8):306-318. https://doi.org/10.47772/IJRISS.2024.808026
Ampiah, M.K., Kovey, J.J., Apprey, C., & Annan, R.A. (2019). Comparative analysis of trends and determinants of anaemia between adult and teenage pregnant women in two rural districts of Ghana. BMC Public Health, 19:1379. https://doi.org/10.1186/s12889-019-7603-6
Araújo Pedrosa, A., Pires, R., Carvalho, P., Canavarro, M.C., & Dattilio, F. (2011). Ecological contexts in adolescent pregnancy: The role of individual, sociodemographic, familial and relational variables in understanding the risk of occurrence and adjustment patterns. Contemporary Family Therapy, 33:107-127. https://doi.org/10.1007/s10591-011-9148-4
Asare, B.Y.A., Baafi, D., Dwumfour-Asare, B., & Adam, A.R. (2019). Factors associated with adolescent pregnancy in the Sunyani Municipality of Ghana. International Journal of Africa Nursing Sciences, 10:87-91. https://doi.org/10.1016/j.ijans.2019.02.001
Asibey, M. O., Abubakari, M., & Peprah, C. (2019). Vulnerability and urban farming: Coping with price volatility in Ejisu-Juaben municipality, Ghana. Cogent Food Agric 5(1):1594504. https://doi.org/10.1080/23311932.2019.1594504
Bah, C. (2014). It’s Young Girls and Women on the Front Lines of the Ebola Crisis. Available from: https://www.unwomen. org/en/news/stories/2014/9/ebola-outbreak-takes-its-toll-on-women
Baker, T. (2020). COVID-19 Aftershocks: Access Denied Teenage Pregnancy Threatens to Block a Million Girls Across Sub- Saharan Africa from Returning to School. World Vision International, 2020-2008. Available from: https://www.wvi.org/sites/default/files/2020-08/2020-08-21-%20 aftershocks%20education%20final2_3.pdf
Bans-Akutey, A., & Tiimub, B.M. (2021). Triangulation in research. Academia Letters, 2:3392. https://doi.org/10.20935/AL3392
Biney, A.A., Kayi, E., Atiglo, D.Y., Sowah, L.R., Badasu, D., & Ankomah, A. (2023). COVID-19, relationships, and contraception: Qualitative perspectives from emerging adults during the COVID-19 lockdown in Accra, Ghana. SSM-Qualitative Research in Health, 3:100216. https://doi.org/10.1016/j.ssmqr.2022.100216
Bronfenbrenner, U. (1979). The Ecology of Human Development: Experiments by Nature and Design. Vol. 2. Harvard, UK: Harvard University Press, p139-163. Available from: https://khoerulanwarbk.wordpress.com/wp-content/uploads/2015/08/urie_bronfen brenner_the_ecology_of_human_developbokos-z1.pdf
Bronfenbrenner, U. (1995). Developmental ecology through space and time: A future perspective. In: Examining Lives in Context: Perspectives on the Ecology of Human Development. United States: American Psychological Association. Available from: https://psycnet.apa.org/ record/1995-98394-018
Campbell, S., Greenwood, M., Prior, S., Shearer, T., Walkem, K., Young, S., et al. (2020). Purposive sampling: complex or simple? Research case examples. Journal of Research in Nursing, 25(8):652-661. https://doi.org/10.1177/1744987120927206
Carter, N., Bryant-Lukosius, D., DiCenso, A., Blythe, J., & Neville, A.J. (2014). The use of triangulation in qualitative research. Oncology Nursing Forum, 41(5), 545-547. https://doi.org/10.1188/14.ONF.545-547
Coast, E., Norris, A.H., Moore, A.M., & Freeman, E. (2018). Trajectories of women’s abortion-related care: A conceptual framework. Social Science and Medicine, 200:199-210. https://doi.org/10.1016/j.socscimed.2018.01.035
Cohen, M.P. (1998). Determining sample sizes for surveys with data analyzed by hierarchical linear models. Journal of Official Statistics, 14(3):267-275.
Cook, S.M., & Cameron, S.T. (2017). Social issues of teenage pregnancy. Obstetrics, Gynaecology and Reproductive Medicine, 27(11):327-332. https://doi.org/10.1016/j.ogrm.2017.08.005
Creswell, J.W., & Creswell, J.D. (2017). Research Design: Qualitative, Quantitative, and Mixed Methods Approach. United States: Sage Publications.
Darroch, J.E., Singh, S., Woog, V., Bankole, A., &Ashford, L.S. (2016). Research Gaps in Adolescent Sexual and Reproductive Health. Available from: https://www.guttmacher.org/report/ research-gaps-in-sexual-and-reproductive-health
Dell, R.B., Holleran, S., & Ramakrishnan, R. (2002). Sample size determination. ILAR Journal, 43(4):207-213. https://doi.org/10.1093/ilar.43.4.207
Donkoh, S., & Mensah, J. (2023). Application of triangulation in qualitative research. Journal of Applied Biotechnology and Bioengineering, 10(1):6-9. https://doi.org/10.15406/jabb.2023.10.00319
Dubik, J.D., Aniteye, P., & Richter, S. (2022). Socio-cultural factors influencing teenage pregnancy in the East Mamprusi Municipality, Ghana. African Journal of Reproductive Health, 26(5): 120-130. https://doi.org/10.29063/ajrh2022/v26i5.13
Eduful, A.K., & Eduful, M. (2022). Malls, modernity and consumption: Shopping malls as new projectors of modernity in Accra, Ghana. Journal of Consumer Culture, 22(4):949-968. https://doi.org/10.1177/14695405211033666
Gettleman, J. (2014). Ebola Orphan’s Plea: ‘Do You Want Me?’. International New York Times. Available from: https://www. nytimes.com/2014/12/14/world/africa/an-ebola-orphans-plea-in-africa-do-you-want-me.html
Ghana Statistical Service, Ghana Health Service, & & ICF International. (2018). Ghana Maternal Health Survey 2017. GSS, GHS, and ICF. Available from: https://www. dhsprogram.com/publications/publication-fr340-other-final-reports.cfm
Ghana Statistical Service. (2021). Brief on COVID-19 Households and Jobs Tracker, Accra, Ghana. Available from: https://statsghana.gov.gh/gsspublications. php?category=mje5mdq4nzg5ms4yndk1/webstats/ p289p3ssr9
Ghana Statistical Service. (2024). Ejisu Municipal District Multidimensional Poverty Fact Sheet. Available from: https://statsghana.gov.gh/gssmain/fileupload/pressrelease/ ejisu%20municipal.pdf
Gyesaw, N.Y.K., & Ankomah, A. (2013). Experiences of pregnancy and motherhood among teenage mothers in a suburb of Accra, Ghana: A qualitative study. International Journal of Women’s Health, 5:773-780. https://doi.org/10.2147/IJWH.S51528
Hall, K. S., Samari, G., Garbers, S., Casey, S. E., Diallo, D. D., Orcutt, M., et al. (2020). Centring sexual and reproductive health and justice in the global COVID-19 response. The lancet, 395(10231), 1175-1177. Available from: https://www.thelancet.com/journals/lancet/ article/PIIS0140-6736(20)30801-1/fulltext
Heale, R., & Forbes, D. (2013). Understanding triangulation in research. Evidence-based Nursing, 16(4):98. https://doi.org/10.1136/eb-2013-101494
Ikamari, L., Izugbara, C., & Ochako, R. (2013). Prevalence and determinants of unintended pregnancy among women in Nairobi, Kenya. BMC Pregnancy and Childbirth, 13:69. https://doi.org/10.1186/1471-2393-13-69
Israel, O.K., Adeomi, A.A., Adeoye, O.A., Israel, M.G., & Olugbenga-Bello, A.I. (2019). Contraceptive knowledge, access and uptake among rural and urban unmarried in-school adolescents in Osun state, Nigeria: A comparative study. Journal of Community Medicine and Public Health, 3(166):2577-2228. https://doi.org/10.29011/2577-2228.100066
Johnson, G.M., & Puplampu, K.P. (2008). Internet use during childhood and the ecological techno-subsystem. Canadian Journal of Learning and Technology, 34(1):n1. https://doi.org/10.21432/T2CP4T
Khare, S.R., & Vedel, I. (2019). Recall bias and reduction measures: An example in primary health care service utilization. Family Practice, 36(5):672-676. https://doi.org/10.1093/fampra/cmz042
Knotters, M., & Brus, D.J. (2013). Purposive versus random sampling for map validation: a case study on ecotope maps of floodplains in the Netherlands. Ecohydrology, 6(3):425- 434. https://doi.org/10.1002/eco.1289
Koka, E., Narh, E., Asante-Poku, A., Adjei, D.K.A., Sebbie, D., Siam, I.M., et al. (2024). Impact of COVID-19 lockdown measures on mother and child health-the case of Ghana. BMC Public Health, 24(1):2724. https://doi.org/10.1186/s12889-024-20264-8
Krugu, J.K., Mevissen, F., Münkel, M., & Ruiter, R. (2017). Beyond love: A qualitative analysis of factors associated with teenage pregnancy among young women with pregnancy experience in Bolgatanga, Ghana. Culture, Health and Sexuality, 19(3):293-307. https://doi.org/10.1080/13691058.2016.1216167
Kumar, N., & Singh, A.K. (2022). Impact of COVID-19 on gender equality, sexual and reproductive health rights of adolescent girls and young women: A narrative review. Current Women’s Health Reviews, 18(3):6-12. https://doi.org/10.2174/1573404817666210707094622
Lu, M., Barlow, J., Meinck, F., & Wu, Y. (2022). “Prevention alone is not enough:” Stakeholders’ perspectives about school-based child sexual abuse (CSA) Prevention programs and CSA research in China. Journal of Interpersonal Violence, 37(7-8):NP5116-NP5142. https://doi.org/10.1177/0886260520959630
Mark, N.D., & Wu, L.L. (2022). More comprehensive sex education reduced teen births: Quasi-experimental evidence. Proceedings of the National Academy of Sciences, 119(8):e2113144119. https://doi.org/10.1073/pnas.2113144119
McCool-Myers, M., Kozlowski, D., Jean, V., Cordes, S., Gold, H., & Goedken, P. (2022). The COVID-19 pandemic’s impact on sexual and reproductive health in Georgia, USA: An exploration of behaviours, contraceptive care, and partner abuse. Contraception, 113:30-36. https://doi.org/10.1016/j.contraception.2022.04.010
Mena-Meléndez, L. (2022). Rural-urban differences in unintended pregnancies, contraceptive nonuse, and terminated Pregnancies in Latin America and the Caribbean. Women’s Reproductive Health, 9(2):119-142. https://doi.org/10.1080/23293691.2021.2016135
Mensah, A. (2021). A/R Highest with Over 1,000 Teenage Pregnancies – GES. Available from : https://3news.com/a-r-highest-with-over-1000-teenage-pregnancies-ges/?fbclid=iwar3pj9t8 108kplwkl4pd0xml-mbh1ajkrgr9igoxzs_ wldkbh42kj3fs0xc
Ministry of Education. (2020). COVID-19 Coordinated Education Response Plan for Ghana. Available from: https://ges.gov.gh/wp-content/uploads/2020/04/education-response-plan-to-covid-19-in-ghana-april-2020-1.pdf
Mohammed, S. (2023). Analysis of national and subnational prevalence of adolescent pregnancy and changes in the associated sexual behaviours and sociodemographic determinants across three decades in Ghana, 1988-2019. BMJ Open, 13(3):e068117. https://doi.org/10.1136/bmjopen-2022-068117
Molla, W., Hailemariam, S., Mengistu, N., Madoro, D., Bayisa, Y., Tilahun, R. et al. (2022). Unintended pregnancy and associated factors during COVID-19 pandemic in Ethiopia: Community-based cross-sectional study. Women’s Health, 18:17455057221118170. https://doi.org/10.1177/17455057221118170
Muhaidat, N., Fram, K., Thekrallah, F., Qatawneh, A., & Al-Btoush, A.A. (2020). Pregnancy during COVID-19 outbreak: the impact of lockdown in a middle-income country on antenatal healthcare and wellbeing. International Journal of Women’s Health, 12:1065-1073. https://doi.org/10.2147/IJWH.S280342
Murewanhema, G., Burukai, T. V., Chireka, B., & Kunonga, E. (2021). Implementing national COVID-19 vaccination programmes in sub-Saharan Africa-early lessons from Zimbabwe: A descriptive cross-sectional study. Pan African Medical Journal, 40(1):180. https://doi.org/10.11604/pamj.2021.40.180.30824
Musa, S.S., Odey, G.O., Musa, M.K., Alhaj, S.M., Sunday, B.A., Muhammad, S.M. et al. (2021). Early marriage and teenage pregnancy: The unspoken consequences of COVID-19 pandemic in Nigeria. Public Health in Practice, 2:100152. https://doi.org/10.1016/j.puhip.2021.100152
Neyman, J. (1992). On the two different aspects of the representative method: The method of stratified sampling and the method of purposive selection. In: Breakthroughs in Statistics: Methodology and Distribution. New York, NY: Springer New York. p. 123-150
Noble, H., & Heale, R. (2019). Triangulation in research, with examples. Evidence-based Nursing, 22(3):67-68. https://doi.org/10.1136/ebnurs-2019-103145
Nyarko, S.H. (2019). Unintended pregnancy among pregnant women in Ghana: Prevalence and predictors. Journal of Pregnancy, 2019(1):2920491. https://doi.org/10.1155/2019/2920491
Nyimbili, F., & Nyimbili, L. (2024). Types of purposive sampling techniques with their examples and application in qualitative research studies. British Journal of Multidisciplinary and Advanced Studies, 5(1):90-99. https://doi.org/10.37745/bjmas.2022.0419
Okalo, P., Arach, A.A., Apili, B., Oyat, J., Halima, N., & Kabunga, A. (2023). Predictors of unintended pregnancy among adolescent girls during the second wave of COVID-19 pandemic in Oyam District in Northern Uganda. Open Access Journal of Contraception, 15-21. https://doi.org/10.2147/OAJC.S399973
Okine, L., & Dako-Gyeke, M. (2020). Drivers of repeat pregnancy among teenage mothers in Accra, Ghana. Children and Youth Services Review, 113:105002. https://doi.org/10.1016/j.childyouth.2020.105002
Owusu-Addo, E., Owusu-Addo, S.B., Bennor, D.M., Mensah- Odum, N., Deliege, A., Bansal, A. et al. (2023). Prevalence and determinants of sexual abuse among adolescent girls during the COVID-19 lockdown and school closures in Ghana: A mixed method study. Child Abuse and Neglect, 135:105997. https://doi.org/10.1016/j.chiabu.2022.105997
Owusu-Addo, S.B., Owusu-Addo, E., & Morhe, E.S. (2016). Health information-seeking behaviours among pregnant teenagers in Ejisu-Juaben Municipality, Ghana. Midwifery, 41:110-117. https://doi.org/10.1016/j.midw.2016.08.007
Patton, M.Q. (2014). Qualitative Research and Evaluation Methods: Integrating Theory and Practice. United States: Sage Publications.
Rai, N., & Thapa, B. (2015). A Study on Purposive Sampling Method in Research. Kathmandu: Kathmandu School of Law, p8-15.
Salazar, J.D., Saithong, T., Brown, P.E., Foreman, J., Locke, J.C., Halliday, K.J., et al. (2009). Prediction of photoperiodic regulators from quantitative gene circuit models. Cell, 139(6):1170-1179. https://doi.org/10.1016/j.cell.2009.11.029
Sandow, J.N., Duodu, E., & Oteng-Abayie, E.F. (2021). Regulatory capital requirements and bank performance in Ghana: Evidence from panel corrected standard error. Cogent Economics and Finance, 9(1):2003503. https://doi.org/10.1080/23322039.2021.2003503
Sandow, J.N., Oteng-Abayie, E.F., Sakyi, D., & Obuobi, B. (2022). Financial sector development and natural resource rents: The role of institutions in Sub-Saharan Africa. Environmental Science and Pollution Research, 29(59):89340-89357. https://doi.org/10.1007/s11356-022-21948-7
Seboka, B.T., Yilma, T.M., & Birhanu, A.Y. (2021). Awareness and readiness to use telemonitoring to support diabetes care among care providers at teaching hospitals in Ethiopia: An institution-based cross-sectional study. BMJ Open, 11(10):e050812. https://doi.org/10.1136/bmjopen-2021-050812
Sedgh, G., Singh, S., & Hussain, R. (2014). Intended and unintended pregnancies worldwide in 2012 and recent trends. Studies in Family Planning, 45(3):301-314. https://doi.org/10.1111/j.1728-4465.2014.00393.x
Selbervik, H. (2020). Impacts of School Closures on Children in Developing Countries: Can We Learn Something from the Past? CMI Brief. Available from: https://hdl.handle. net/11250/2653654
Shikuku, D.N., Nyaoke, I.K., Nyaga, L.N., & Ameh, C.A. (2021). Early indirect impact of COVID-19 pandemic on utilisation and outcomes of reproductive, maternal, newborn, child and adolescent health services in Kenya: A cross-sectional study. African Journal of Reproductive Health, 25(6):76-87. https://doi.org/10.29063/ajrh2021/v25i6.9
Singh, A.S., & Masuku, M.B. (2014). Sampling techniques and0 determination of sample size in applied statistics research: An overview. International Journal of Economics, Commerce and Management, 2(11):1-22.
Sully, E.A., Biddlecom, A., Darroch, J.E., Riley, T., Ashford, L.S., Lince-Deroche, N., et al. (2020). Adding it up: Investing in sexual and reproductive health 2019. United States: Guttmacher Institute.
Sutton, A., Lichter, D.T., & Sassler, S. (2019). Rural–urban disparities in pregnancy intentions, births, and abortions among US adolescent and young women, 1995–2017. American Journal of Public Health, 109(12):1762-1769. https://doi.org/10.2105/AJPH.2019.305318
Talbot, K., Talavera, P., Schutz, F., & Ruiz-Casares, M. (2023). Pre-/post-assessment of a sexual and reproductive health training program for young people in Namibia. Global Journal of Health Science, 15(1):1-47. https://doi.org/10.5539/gjhs.v15n1p47
The Lancet Child Adolescent Health. (2020). Pandemic school closures: Risks and opportunities. The Lancet Child and Adolescent Health, 4(5):341. https://doi.org/10.1016/s2352-4642(20)30105-x
UNICEF. (2018). Available from: https://www.unicef.org/eap/ media/3696/file/Adolescent%20pregnancy.pdf
UNICEF. (2020). Unequal Access to Remote Schooling Amid COVID‐19 Threatens to Deepen Global Learning Crisis. Available from: https://www.unicef.org/press-releases/ unequal-access-remote-schooling-amid-COVID-19- threatens-deepen-global-learning [Last accessed on 2020 July 02].
United Nations Children’s Fund (UNICEF). (2022). Impact of COVID-19 on Adolescent Girls in Ghana: A Mixed-method study. Available from: https://www.unicef.org/ghana/ media/5196/file/the%20impact%20of%20covid-19%20on%20adolescent%20girls%20in%20 ghana.pdf
United Nations Population Fund (UNPF). (2023). Adolescent Pregnancy in Ghanaian Communities: A Worrying Trend. Available from: https://ghana.unfpa.org/en/ news/adolescent-pregnancy-ghanaian-communities-%E2%80%93-worrying-trend-amid-mtct-hiv-0
Wasswa, R., Kabagenyi, A., & Atuhaire, L. (2020). Determinants of unintended pregnancies among currently married women in Uganda. Journal of Health, Population and Nutrition, 39:1-17. https://doi.org/10.1186/s41043-020-00218-7
World Health Organization. (2016). Global Health Estimates 2015: Deaths by Cause, Age, Sex, by Country and by Region, 2000-2015. Geneva: WHO. Available from: https://www. who.int/data/gho/data/themes/mortality-and-global-health-estimates
World Vision Ghana (2020). COVID-19 in Krachi West District. Available from: https://www.myjoyonline.com/world-vision-ghana-intensifies-covid-19-fight-in-krachi-west-with-second-batch-of-ppe-donation
Worldatlas. (2017). World Facts: Highest Teen Pregnancy Rates Worldwide 2015. Available from: https://www.worldatlas. com/articles/highest-teen-pregnancy-rates-worldwide.html
Zulaika, G., Bulbarelli, M., Nyothach, E., van Eijk, A., Mason, L., Fwaya, E. et al. (2022). Impact of COVID-19 lockdowns on adolescent pregnancy and school dropout among secondary schoolgirls in Kenya. BMJ Global Health, 7(1):e007666. https://doi.org/10.1136/bmjgh-2021-007666