Attachments
Executive summary
Adolescent pregnancy remains a major public health concern in Southeast Asia. Adolescent pregnancy poses risks to the health and wellbeing of adolescent girls and their babies. In many contexts, adolescent pregnancy is closely linked to child marriage and early union. The adolescent fertility rate in Malaysia has been halved since the 1990s but has stagnated over the last few years (UN DESA Population Division, 2022). While this could be linked to child marriage and early union practices, publicly available and centralized data on child marriage in Malaysia are limited and so it is difficult to gauge the scale of child marriage in the country (Girls Not Brides, 2023). In addition, research suggests that the prevalence of adolescent childbearing may be underestimated as data on illegal abortion and abandoned babies among adolescents in Malaysia are not taken into account (Hazariah et al., 2021; Suan et al., 2015). There is limited research into the drivers of and pathways to adolescent pregnancy in Southeast Asia, and few studies capture the opinions and experiences of the girls themselves, which should be key in designing policy and interventions.
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 on pathways to adolescent pregnancy was conducted in four countries, this specific report discusses study implementation and findings only from Malaysia.
Using a participatory, qualitative approach, the study design placed adolescent perspectives at the forefront, using primary data collected with adolescent girls aged 16–20 who experienced pregnancy or birth at age 18 or younger. Study implementation was guided by a working group led by the United Nations Population Fund (UNFPA) and the United Nations Children’s Fund (UNICEF), and two youth advisors from the study country. Data collection was conducted in three states representing median (Selangor and Kuala Lumpur) and high (Pahang) adolescent fertility and premarital conception.
During the first round of data collection, an in-depth, timeline interview approach was used. Framework analysis was applied during preliminary data analysis, 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.
A total of 45 in-depth interviews were conducted with adolescent girls and six pathways to adolescent pregnancy were identified. These pathways were differentiated primarily according to the timing of first pregnancy relative to any union, that is, outside-union and withinunion pregnancies. Outside-union pregnancy pathways all resulted in unplanned pregnancies but were differentiated further according to the context of sex that preceded pregnancy (consensual, pressured, forced) and whether or not pregnancy was followed by union. Withinunion pregnancy pathways diverged according to who initiated the union, as well as pregnancy intention (planned, unplanned but wanted). Crosscutting factors contributing to girls’ pathways to adolescent pregnancy included lack of sexual and reproductive health (SRH) knowledge (including contraception), barriers to contraceptive access and use, girls’ lack of agency and decision-making power in relationships, and social norms that support marriage as a means to protect a girl and her family’s reputation.
During 10 follow-up interviews, adolescent girls offered several recommendations. They said that programmes and policies should focus on teaching girls about SRH and related topics. They would like to see the creation of a supporting, enabling environment for girls to access SRH information, services and supplies, and one that provide girls with guidance so they can have more say in their relationships. They recommended that girls receive targeted support following experiences of sexual violence, and they asked that parenting classes and financial and moral support be provided to girls who are already pregnant or parents.
The study found diverse pathways to adolescent pregnancy among girls in Malaysia, some of which are not driven by marriage or cohabitation. The findings highlight the need to ensure that girls have the resources that they need to make informed decisions that affect their sexual and reproductive health before they become sexually active. This will entail assessing the delivery of timely and accurate SRH information in schools and providing comprehensive sexuality education in school and through non-formal, communitybased programmes. It will likewise be imperative to address the social and legal barriers girls face to contraceptive access and use. This will necessitate the transformation of social norms and removal of age limits and requirements for parental consent so that unmarried adolescents can freely access contraceptives, whether through private establishments or public healthcare facilities. Finally, given that some girls’ pathways to pregnancy were characterized by pressured and forced sex, it will be important to implement comprehensive sexuality education (CSE) and gender transformative programming (with girls and boys) that address harmful gender norms, communication, consent and violence. It will also be important to ensure that girls have access to comprehensive sexual and reproductive health care to make the best-informed decisions, and receive targeted support and clear legal guidance following experiences of sexual violence, alongside access to a child-friendly justice process.
Future research could explore girls’ decision-making and contexts following admission to shelter homes, as this was a critical component of many girls’ experiences of pregnancy and unique to the Malaysian setting (relative to other countries where this study was also undertaken). Given the limited number of participants and locations included in this study, more qualitative research (i.e. with more girls in more locations) would enable more robust data analysis and help to identify other pathways to adolescent pregnancy that may be salient in the experiences of girls from socio-cultural and ethnolinguistic backgrounds not included in this study (e.g. Chinese and Indian). It would also be beneficial to gather quantitative data on the pathways to adolescent pregnancy at the national level so that national programmes and policies can be tailored to girls’ specific contexts and needs.