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Executive summary
Adolescent pregnancy is a major public health priority in Southeast Asia. In Indonesia, most adolescent pregnancies occur within the context of union (marriage or cohabitation), but about one in four women conceived outside of union, and of these women, 92 per cent were married or in a union by the time they gave birth (Harvey et al. 2022). Data also suggest that pregnancies outside of marriage are becoming more common in Indonesia (Harvey et al., 2022). Little is known about adolescent girls’ pathways to adolescent pregnancy, particularly those that occur outside of union.
This study aimed to 1) understand the different drivers and pathways to adolescent pregnancy, and 2) co-develop, with adolescents, policy and programming recommendations to effectively address adolescent pregnancy. The findings of this study can help inform strategic investments and interventions that address specific pathways to and drivers of adolescent pregnancy, thereby enabling girls to make informed decisions for their relationships and life trajectories.
While this study was conducted in four countries, this report discusses study implementation and findings from Indonesia only.
Using a participatory, qualitative approach, the study design placed adolescent perspectives at the forefront, using primary data collected with adolescent girls aged 16-20 years who experienced pregnancy or birth at age 18 or younger. Study implementation was guided by a working group from UNFPA and UNICEF, and two youth advisors from the study country. Data collection was conducted in two provinces, West Java and Central Sulawesi, representing median and high adolescent fertility and premarital conception, respectively.
An in-depth, timeline interview approach was used during the first round of data collection. During preliminary data analysis, a framework analysis was applied and candidate pathway typologies were developed based on girls’ life stories and contributing factors in their pathway to adolescent pregnancy. During the second round of data collection, follow-up interviews were conducted with selected girls to validate and clarify study findings and interpretations and gather girls’ recommendations for programmes and policy.
Interviewers spoke with 79 girls and identified six pathways to adolescent pregnancy. These pathways were broadly differentiated according to timing of first pregnancy relative to union – that is, outside-union, or within-union. Outside-union pathways were more common in our sample and were further differentiated according to the context of sex preceding pregnancy (forced, unwanted or pressured, consensual). Within-union pathways were differentiated according to the main motivation for union (love, reputational, financial). Crosscutting factors contributing to girls’ pathways to adolescent pregnancy included acceptability of child marriage and stigma of premarital pregnancy, partner and family expectations of pregnancy soon after marriage, sexual violence and harmful norms (including local customs that encourage girls to marry at a young age), and contraceptive information, support, and access.
During 19 follow-up interviews, adolescent girls recommended that programmes and policies should consider using interpersonal and informal approaches to sexuality education, engaging girls’ mothers and friends and using real-life experiences and scenarios in learning materials, using social media to disseminate sexual and reproductive health (SRH) information, and teaching girls about puberty, menstrual health, sex, pregnancy, and contraception. Girls also recommended providing girls with counselling support, including boys and parents in information and education campaigns, making contraceptives available through online and private spaces, and providing support to girls who experience forced sex or rape.
The findings highlight many drivers of adolescent pregnancy in Indonesia, and the diversity of girls’ lived realities that lead to adolescent pregnancy in two provinces. The findings suggest that reducing unplanned adolescent pregnancy is a critical step toward eliminating child marriage. This will require interventions that prioritize attending to harmful gender norms, increasing girls’ communication skills and agentic power in intimate relationships, engaging men and boys in critically examining gendered sexual scripts, and fostering equal power between partners in relationships. It is also imperative to establish and enforce clear legal and social consequences for perpetrators of gender-based violence. Ensuring that sexuality education provided to adolescents is essential and it should be comprehensive and gender transformative and incorporates in-depth learning opportunities and dialogue on healthy, respectful relationships, consent, and life skills. Equally important is ensuring accessibility and availability of contraception for adolescent and unmarried girls and women by addressing the current legal, structural, and community-level barriers to access, alongside addressing barriers to contraceptive use and sexual violence through gender transformative programming, policy, and advocacy.
Future research should explore the prevalence of different pathways to adolescent pregnancy at national and subnational levels, and the prevalence of relationship outcomes following adolescent pregnancy (e.g. dual parenthood, single parenthood, intimate partner violence, separation/divorce). Future qualitative research could focus on developing a better understanding of young people’s alcohol use behaviour and its links to sexual violence, male partners/husbands’ motivations for pregnancy and their knowledge and attitudes regarding different contraceptive methods, and whether spousal age gap influences couples’ contraceptive use.