A Comparative Analysis of Adolescent Pregnancy Contributing Factors in Rural and Urban Zambia: A Case Study of the Eastern and Southern Provinces

Adolescent pregnancy remains a pressing public health and developmental challenge in Zambia, with 29% of adolescent girls under the age of 18 becoming mothers. Significant rural-urban disparities persist, with prevalence rates of 37% in rural areas compared to 17% in urban settings. Adolescent pregnancy contributes to a host of negative outcomes, including maternal mortality, school dropout, sexually transmitted infections (STIs), and child marriage. Despite ongoing sexual and reproductive health (SRH) interventions, reductions in adolescent pregnancy rates remain limited, suggesting underlying structural and contextual factors that require further exploration. However, existing literature often fails to provide comparative insights across geographic settings, leaving a critical gap in understanding how location-specific dynamics shape adolescent pregnancy risks. A comparative mixed-methods cross-sectional design was employed, guided by Bronfenbrenner’s Socio-Ecological Model (SEM). Quantitative data were collected through structured questionnaires from 400 adolescents aged 18-19 and young women aged 20-24 across selected districts in the Eastern and Southern provinces. Qualitative data were gathered through 12 focus group discussions (FGDs) and 20 key informant interviews (KIIs) involving parents, healthcare providers, teachers, and community leaders. The study examined multilevel determinants; individual, interpersonal, community, and policy using descriptive statistics and binary logistic regression for quantitative data, and thematic content analysis for qualitative data. The findings revealed significantly higher adolescent pregnancy rates in rural areas, largely driven by early sexual debut, poverty, child marriage, limited contraceptive access, and sociocultural practices such as initiation ceremonies. In urban settings, contributing factors included peer pressure, constrained parental oversight, and gaps in youth-friendly service availability. Key predictors across both contexts included age at first sex, education level, and contraceptive use, with marital status and SRH service utilization showing stronger associations in rural areas. The study underscores the contextual complexity of adolescent pregnancy and highlights the need for geographically tailored interventions. It contributes evidence to inform integrated strategies that expand adolescent-responsive SRH services and economic opportunities. Strengthening community engagement, especially with parents and traditional leaders, alongside better enforcement of child protection and SRH policies is essential to reducing adolescent pregnancy and improving adolescent well-being in Zambia. Further research should examine long-term impacts and intervention effectiveness.