Relationship dynamics and teenage pregnancy in South Africa

Teenage pregnancy is extremely common in South Africa. Whilst its 'problema tic' nature is a subject of debate, it reflects a pattern of sexual activit y which puts teenagers at risk of HIV. Currently one in five pregnant teena gers is infected with the virus. This creates a new imperative to understan d teenage pregnancy and the pattern of high risk sexual activity of which i t is one consequence. This was an exploratory study undertaken to investiga te factors associated with teenage pregnancy amongst sexually active adoles cents in an urban and peri-urban context. The study used a matched case con trol design. with 191 cases and 353 school or neighbourhood, age-matched co ntrols. Subjects were under 19 rears and recruited from township areas of C ape Town. A structured questionnaire was used to obtain information on soci o-economic factors, contraceptive knowledge and use, and sexual behaviour. Conditional logistic regression was used to analyse the relationship betwee n teenage pregnancy and the factors investigated. The results presented foc us on relationship dynamics and their association with the risk of pregnanc y. Both groups of teenagers had been dating for a mean of two and a half ye ars and about half were still with their first sexual partner. The partners of the pregnant teenagers were significantly older, less likely to be in s chool and less likely to have other girlfriends. The pregnant teenagers wer e significantly more likely to have experienced forced sexual initiation an d were beaten mon often. They were much less likely to have confronted thei r boyfriend when they discovered he had other girlfriends. Multiple modelli ng shows that both forced sexual initiation and unwillingness to confront a n unfaithful partner are strongly associated with pregnancy and also relate d to each other. We argue that the associations are mediated through unequa l power relations within the relationship which are reinforced by violence. We further discuss indicators of greater intimacy within relationships of the pregnant teenagers which may suggest that more of the pregnancies were wanted than was suggested. Both of these conclusions pose critical challeng es for health promoters. (C) 2001 Elsevier Science Ltd. All rights reserved .