|dc.description.abstract||Adolescents in Zambia face complex and significant challenges in addressing their sexual and reproductive health (SRH) needs and this is evident in the rise in adolescent pregnancies. According to the Ministry of Education, Science, Vocational Training and Early Education bulletins of 2012, 2012 and 2014; 14 773, 15 707 and over 16 000 girls dropped out of school due to teenage pregnancy respectively. The implications of adolescent fertility include fistula, unsafe abortions, school drop outs and a huge health cost burden on the nation.
The aim of the study was to investigate the factors that influence adolescent fertility in Zambia, guided by the following objectives; examining the relationship between social, economic and demographic factors and adolescent fertility in Zambia; establishing whether or not service provider attitude is a barrier to access to contraceptive services by adolescents; identifying and analysing the explanatory variables of adolescent fertility in Zambia; and examining the differences between determinants of adolescent fertility for married and unmarried adolescents.
This research employed a cross sectional study design using the 2013/2014 Zambia Demographic and Health Survey to examine social, economic and demographic determinants of adolescent fertility. The study population consisted of married and unmarried female adolescents aged 15-19 years in Zambia who had or had no birth(s) in the five years preceding the survey. Qualitative data was collected through focused group discussions at youth friendly health corners, in Government health facilities. Data was analysed using the Statistical Package for Social Sciences Software (SPSS). The multi variable regression analysis was employed. Statistical tests specifically descriptive, multivariate and bivariate correlations analysis were performed in order to analyse the relationships between or among variables. Qualitative data was transcribed and then manually analysed using themes.
Study findings through the quantitative analysis revealed that older adolescents were 4 times more likely to experience adolescent fertility than younger adolescents. The odds of having adolescent childbearing were 1.4 times higher among adolescents living in rural areas compared to adolescents living in urban areas. When taking all factors into consideration, socio-economic and proximate variables downplay socio-demographic variables. The influence of proximate variables marriage and contraceptive use on adolescent fertility is very significant.
The low contraceptive use revealed in the quantitative analysis is explained in the qualitative analysis by the negative service provider attitude and lack of service provider training to deliver comprehensive youth friendly sexual and reproductive health services. The health providers interviewed in the study attributed the escalating teenage pregnancies to teenagers shunning contraception services in fear of being seen by parents, guardians and friends. This view is consistent with that of the adolescents, for not visiting the health facilities to access contraceptives.
The study shows that there is a need to scale up operationalisation of youth friendly health corners in government health centres and capacity building to health service providers to provide youth friendly health services; and scaling up of Comprehensive Sexuality Education for both in and out of school adolescents because early initiation of sexual intercourse in the absence of comprehensive information and services exposes adolescents to risk of childbearing and sexually transmitted diseases.||en