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. 2026 Jan 19;16:5689. doi: 10.1038/s41598-026-36450-0

Adolescent pregnancy estimates, spatial distribution, and policy implications in the Volta Region, Ghana, 2019–2023

Chrysantus Kubio 1,2,✉, Williams Azumah Abanga 3, Victor Zeng 4, Samuel Adolf Bosoka 5, Maxwell Afetor 4, Ignatius Aklikpe 4, Desmond Klu 6, Senanu Kwesi Djokoto 1, Frank Baiden 2
PMCID: PMC12891003  PMID: 41555009

Abstract

Adolescent pregnancies remain high in Ghana despite the implementation of policies and programs to reduce cases. However, there is limited evidence on the epidemiology of adolescent pregnancies, particularly in the Volta Region. To address this gap, we determined the incidence and distribution of adolescent pregnancies in the Volta Region to provide critical insights to inform targeted interventions and policy improvements. We extracted pregnancy data in the Volta Region from the District Health Information Management System II (DHIMS-II) for the period 2019 to 2023. The incidence of adolescent pregnancy was determined by dividing the number of pregnant adolescents by the total female adolescent population per 1,000. Descriptive statistics were performed by person, place and time, and the results were presented in tables, graphs and maps. Of the 217,813 pregnancies reported by health facilities, 13.5% (29,487/217,813) were adolescent pregnancies. The average incidence of adolescent pregnancies was 14.8 per 1,000 [95% CI 14.5–15.2], with the highest, 142 per 1,000 [95% CI 141–144] among those aged 15–19 years. The incidence was higher in 2021, 16.7 per 1,000. The Central Tongu District recorded a notably high rate of adolescent pregnancies, 175 per 1,000. This study highlights a high incidence of adolescent pregnancies, particularly among older adolescents in the Volta Region with geographical disparities. The Regional Health Directorate and adolescent development stakeholders should implement targeted interventions in high-rate districts. Further studies are needed to evaluate the effectiveness of ongoing adolescent health interventions and explain inter-district disparities in the incidence of adolescent pregnancies.

Supplementary Information

The online version contains supplementary material available at 10.1038/s41598-026-36450-0.

Keywords: Adolescent pregnancy, Incidence, Estimate, Epidemiology, Spatial analysis, Public health policy, Volta region, Ghana

Subject terms: Health care, Medical research

Background

The occurrence of adolescent pregnancies can have severe public health effects1–3. Pregnancy during adolescence may interrupt girls’ education, negatively affecting future employment and income levels4. The biological immaturity of adolescents is a significant risk factor for adverse pregnancy and child health outcomes, including fetal growth restriction, preeclampsia, preterm delivery, stillbirth, and child and maternal mortalities2,3,5. Children born to adolescent mothers are also less likely to attain secondary education6.

Adolescence is an essential critical stage of human growth and development, laying the foundation for lifelong health7. As a result, global efforts to improve adolescent well-being and development have focused on reducing pregnancy occurrence through sexual and reproductive health programs8,9. These initiatives have led to the scaling-up of contraceptive and safe abortion services, sex education and legislation against child marriages to promote safe adolescence4,10. Multi-sectoral strategies and the implementation of multifaceted interventions have been recommended as effective approaches to reducing unplanned adolescent pregnancies and their associated consequences11–13.

Annually, an estimated 21 million adolescents aged 15–19 years in lower-middle-income countries become pregnant. A notable proportion (55%) of these pregnancies are unplanned, resulting in high unsafe abortions4,14. Globally, the birth rate among young adolescent girls aged 10–14 years is estimated at 1.5 per 1,000, with a higher rate of 4.4 reported in sub-Saharan Africa (SSA)15. Studies indicate varying trends in adolescent pregnancy rates across resource-limited countries16–18. Geographical disparities in pregnancy occurrence during adolescence have been reported in multiple SSA countries, with pregnancies occurring more frequently among older adolescents17,19–23.

In Ghana, the Adolescent and Youth-friendly Health Service Guidelines24 and the Reproductive, Maternal, Newborn, Child and Adolescent Health and Nutrition (RMNCAHN) Strategic Plan 2020–202525 provide a framework to promote the well-being and development of adolescents. These policies emphasize the need for essential services to address adolescents’ sexual and reproductive health needs. Despite these efforts, adolescent pregnancy remains prevalent in Ghana, with a reported rate of 11.8% in the Volta Region26. Factors influencing this phenomenon include poverty, inadequate sexual and reproductive health education, low contraceptive uptake, child marriages and sexual abuse27,28. Although studies in the Volta Region have examined contraceptive use among adolescents29, sexual and reproductive health30 and pregnancy experiences23,31–33, there is a paucity of information on the estimated incidence and geographical distribution of adolescent pregnancies in the region. Analyzing adolescent pregnancies reported to health facilities in the region will help inform local health authorities to understand the magnitude of the issue. This study aims to contribute to developing interventions that mitigate adolescent pregnancies while informing policymakers and stakeholders on strategies to improve access to essential antenatal care and child health services for adolescent mothers. We estimated the incidence of adolescent pregnancies in the Volta Region of Ghana using routine health facility data.

Methods

Study design

We conducted a secondary data analysis of adolescent pregnancies reported to health facilities in the Volta Region of Ghana from 2019 to 2023.

Study site

The study was conducted in the Volta Region of Ghana, which comprises 18 districts. The region has an estimated population of 1.7 million, with 392,345 female adolescents34. Approximately 47.6% of women aged 15–49 years have completed secondary education and the majority of employed women work in the sales and services sector26. The region has 557 health facilities providing antenatal care (ANC) services for pregnant women, most of which are Community-based Health Planning Services (CHPS) facilities. CHPS is a national initiative designed to provide primary healthcare, including essential adolescent and sexual health services, through community collaboration and planning. Figure 1 shows a map of the Volta Region with boundaries of the various districts adopted from a previous study35.

Fig. 1.

Fig. 1

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Volta Region map showing district boundaries.

Inclusion and exclusion criteria

We included all records of pregnancies reported among females aged 10–19 years from all health facilities in the Volta Region between 1 January 2019 and 31 December 2023. We used records that contained age, reporting facility, and reporting period. We excluded records with missing age or missing pregnancy status and those outside the study region or timeframe.

Data collection

We extracted the first ANC visit data from the District Health Information Management System II (DHIMS-II). DHIMS-II is a web-based platform used to manage health information in Ghana. ANC is one of the health events recorded in the DHIMS-II database. Pregnant women attending health facilities for their initial ANC visit are usually recorded in ANC clinic registers and subsequently reported into the DHIMS-II through monthly midwife’s returns (Form A). We retrieved data on pregnant women seeking initial ANC using the pivot table function of DHIMS-II. The extracted variables were age, district and year of reported pregnancies. The data extraction process was adapted from a previous study in the Volta Region using DHIMS-II data36 and is illustrated in Fig. 2. The DHIMS-II database was chosen because it provides representative routine health data across districts. This makes it a reliable source for analysing the incidence of adolescent pregnancies. Also, its standardised reporting procedures ensure there is credibility of the data to support evidence-based decision-making. Even though studies indicate that Ghana’s maternal health service data completeness and accuracy exceed 90%37,38, data validity and reliability were ensured by cross-checking the data extracted from DHIMS-II with the facility’s monthly reports and antenatal care registers. This helped to ascertain the accuracy and completeness of the data.

Fig. 2.

Fig. 2

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Data extraction process.

We acknowledge that routine health data may still contain reporting biases such as under-reporting or misclassification, but the verification processes helped reduce these potential errors. The DHIMS-II database was chosen to ensure representative data on adolescent pregnancies across the Volta Region. Also, the use of data from the database helps in the use of routine health data for decision-making.

Data analysis

The extracted data were exported to Microsoft Excel 2019 for analysis using Stata version 17. The data were analyzed descriptively based on person, place, and time, using frequencies, proportions and rates with their confidence intervals. Additionally, Quantum Geographical Information System (QGIS) software version 3.30 was used to create choropleth maps illustrating the distribution of cases by district. A choropleth map uses a colour gradient to show variations in a quantitative variable across different geographical locations. The QGIS join tool was used to link the shapefiles to district names and estimate the incidence of adolescent pregnancies. The estimated district incidence was displayed with graduated colour using the symbology tool. The annual incidence of adolescent pregnancies was estimated by dividing the annual number of documented adolescent pregnancies by the yearly population of female adolescents. To calculate the average incidence, the five-year average female adolescent population was used in conjunction with the average recorded adolescent pregnancies over the study period. The incidence was expressed per 1,000 adolescent population. The 95% confidence intervals were calculated in Stata using the epidemiological calculator with a Poisson distribution. The findings were presented using maps, charts, and tables.

Ethics approval

The Volta Regional Health Directorate provided administrative permission for this study to access and use the DHIMS II dataset. The study did not receive ethical approval because the data were generated and used for routine service provision. Furthermore, the study did not require any informed consent because pregnancy is reported in the DHIMS-II as anonymized aggregate data without personal identifiers. These align with the Ghana Public Health Act, 2012 (851), which mandates the Ghana Health Service to maintain and update surveillance data for epidemic-prone diseases and public health events39. The extracted data was stored on password-protected computers accessible only to the research team. Meanwhile, we ensured that our analysis adhered to the ethical principles outlined in the World Medical Association Declaration of Helsinki and relevant data protection regulations.

Results

Characteristics of adolescent pregnancies

Over the five years, health facilities reported a total of 217,813 pregnancies, of which 13.5% (29,487/217,813) occurred among adolescents. The majority of these pregnancies, 96.7% (28,511/29,487), were among adolescents aged 15–19 years. The highest number of adolescent pregnancies was recorded in 2021, accounting for 21.3% (6,294/29,487) of all adolescent pregnancies (Table 1).

Table 1.

Characteristics of adolescent pregnancies reported to health facilities, Volta Region, 2019–2023.

Year ANC registrants Adolescent pregnancies
Early [10–14 yr] (%) Late [15–19 yr] (%) Total
2019 41,370 196 (3.4) 5,614 (96.6) 5,810
2020 44,811 160 (2.6) 5,895 (97.4) 6,055
2021 44,158 237 (3.8) 6,057 (96.2) 6,294
2022 44,667 201 (3.3) 5,838 (96.7) 6,039
2023 42,807 182 (3.4) 5,107 (96.6) 5,289
Total 217,813 976 (3.3) 28,511 (96.7) 29,487
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Incidence of adolescent pregnancies

Over the five years, the average incidence of adolescent pregnancies in the Volta Region was 14.8 per 1,000. The incidence was higher among adolescents aged 15–19 years, at 14.2 per 1,000 (Table 2). The highest incidence, 16.7 per 1,000, was recorded in 2021., with a steady decline observed between 2021 and 2023 (Fig. 3). Central Tongu recorded the highest incidence, with 175 cases per 1,000 (Fig. 4).

Table 2.

Incidence of adolescent pregnancies reported to health facilities, Volta Region, 2019–2023.

Variable Female adolescent population Adolescent pregnancies
Number Incidence per 1,000 [95% CI]
Age (in years)
 10–14 196,936 976 5.0 [4.7–5.3]
 15–19 200,452 28,511 142.2 [140.7–143.8]
Year
 2019 412,271 5,810 14.1 [13.7–14.5]
 2020 421,590 6,055 14.4 [14.0–14.7]
 2021 376,459 6,294 16.7 [16.3–17.1]
 2022 384,276 6,039 15.7 [15.3–16.1]
 2023 392,345 5,289 13.5 [13.1–13.8]
 Average 397,388 5,897 14.8 [14.5–15.2]
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Fig. 3.

Fig. 3

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Trends of adolescent pregnancies reported to health facilities, Volta Region, 2019–2023.

Fig. 4.

Fig. 4

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District variation of adolescent pregnancies reported to health facilities, Volta Region, 2019–2023.

Discussion

We estimated adolescent pregnancies in the Volta Region using routine health facility data and reported an average incidence of 14.8 per 1,000. Over the five-year period, the incidence of adolescent pregnancies showed a steady decline, with most pregnancies occurring among older adolescents and exhibiting geospatial disparities. This is the first study from our literature search to have estimated the incidence of adolescent pregnancies in the Volta Region. Previous studies described the prevalence16,23,40.

The incidence of adolescent pregnancies reported in our study suggests that adolescent pregnancy remains a significant public health concern in the Volta Region. This finding highlights the potential risk of adverse maternal and, child health and development outcomes in the region41. The low utilization of sexual and reproductive health services, including contraceptive use among adolescents in the region29,30, may contribute to unsafe sex practices, leading to these pregnancies. To address this issue, strict enforcement of legislation on child sexual exploitation and abuse is necessary to help reduce the occurrence of unintended adolescent pregnancies. Furthermore, safe adolescence campaigns should be intensified to raise community awareness of the health, psychosocial and economic consequences of adolescent pregnancies. Additionally, sexual and reproductive health education should be integrated into school health programs at the junior and senior high school levels to equip adolescents with the requisite knowledge to prevent pregnancies. Moreso, it may be imperative for the Ministries of Education, Health, and Gender, Children and Social Protection to consider the integration of sexual and reproductive health education into the national school curriculum to help mitigate adolescent pregnancies.

Furthermore, our findings indicate that adolescent pregnancies generally declined over the five years, with a notable decreasing trend observed from 2021 to 2023. Consistent with our finding, a study in Ethiopia reported a general decline in pregnancies among adolescents aged 15–19 years18. This suggests that adolescent health policies and interventions implemented over the years may have contributed to reducing unintended pregnancies. The national adolescent health policies and strategic frameworks, including the Adolescent Health Service Policy and Strategy, have prioritized reproductive health education and access to youth-friendly services. Improvements in girls’ education and school retention initiatives, such as the capitation grant and school feeding programs, may have contributed to delaying early pregnancies by keeping girls in school longer. Furthermore, the expansion of family planning services and improved contraceptive access for adolescents through community-based health planning and services (CHPS) compounds have enhanced reproductive health service delivery in both urban and rural areas. Community-based health education programs targeting adolescents, parents, and community leaders have also increased awareness about the risks of early pregnancy and the importance of delaying childbearing. The increase in the median age of first marriage (from 20.5 to 21.7 years for women aged 25–49) in the Volta Region may have played a role in the decline in the incidence of adolescent pregnancy26,42. However, given the descriptive nature of our study, we cannot establish causal relationships between these specific policy interventions or socioeconomic factors and the observed decline. The temporal pattern we identified warrants further investigation through analytical studies specifically designed to test hypotheses about potential drivers of change and to establish temporal associations with policy interventions or socioeconomic shifts. Future research employing quasi-experimental designs, such as interrupted time series analysis or difference-in-differences approaches, would provide more robust evidence on the effectiveness of specific interventions in reducing adolescent pregnancies.

Local health authorities and adolescent development agencies should implement strategies to sustain the decreasing trend and further promote safe adolescence. In contrast, a study in Ghana reported an unstable trend of adolescent pregnancies between 1988 and 2019, with an increasing trend over the past decade16. Similarly, in Nicaragua, adolescent pregnancies showed a steep decline followed by an increase17. These differences may be attributed to the use of national demographic and health survey data, which are community-based. In contrast, our study relied on routine health facility data to estimate incidence. The use of different data sources and incidence-based estimation versus prevalence studies could explain the disparities in trends across studies. Additionally, variations in healthcare-seeking behavior, completeness of facility-based reporting, and access to antenatal care services across different contexts may influence the patterns observed in facility-based data compared to population-based surveys.

Our study also found that older adolescents (15–19 years) were more affected. Similar findings have been reported in Nicaragua17 and Sao Tome and Principe19, where adolescent pregnancies were predominantly among those aged 15 years and above. Additionally, a study in the Kpando Municipality of the Volta Region revealed that most adolescent mothers were older than 15 years23. In Ghana, 6% of female adolescents are married by age 15 and 23% by age 1826. These early marriages may inhibit adolescents’ sexual autonomy, increasing their vulnerability to unintended pregnancies. Furthermore, Ghana’s legal age of sexual consent (16 years) could be contributing to sexual exploitation and transactional sex between young girls and adults, thereby increasing pregnancy risk. In Hohoe, a district in the Volta Region, a study has shown that adolescents engage in sexual relationships to meet basic needs, often leading to unplanned pregnancies31. Additionally, 50% of women in Ghana initiate sexual intercourse by 18 years, which may further explain the high incidence of pregnancies among older adolescents in the Volta Region26.

Although adolescent pregnancies primarily occur during late adolescence, pregnancies among early adolescents (10–14 years) remain a critical public health concern due to their associated health and development risks. The strict enforcement of child sexual rights regulations is crucial to protect young adolescents from sexual exploitation by adults. Moreover, child protection agencies should implement programs and strategies to eliminate socio-cultural tolerance of inter-generational sexual relationships23, which contribute to adolescent pregnancies. Young adolescents generally have limited knowledge of sexual and reproductive health, and low utilization of available services30. Furthermore, campaigns aimed at males to raise awareness of the adverse effects of engaging in sexual activity with young adolescents may help mitigate pregnancies.

We also found inter-district disparities in adolescent pregnancy incidence, with some districts reporting significantly higher rates than others. Rural-urban disparities may influence these geographical differences, as adolescent pregnancies tend to be more prevalent in rural areas than in urban communities in Ghana16. Additionally, variations in early sexual debut43 and child marriage prevalence44,45 across different districts in the Volta Region may have contributed to these disparities in adolescent pregnancies. Furthermore, socioeconomic, cultural and demographic characteristics21,46 are also potential drivers of the geographical variations in adolescent pregnancy incidence. There is a geographic disparity regarding access to education, healthcare, and social services in the Volta Region. This may account for the observed inter-district variations in adolescent pregnancies47. Future studies employing multivariable analyses that adjust for population denominators, healthcare infrastructure, and data quality indicators would provide more robust evidence on the true extent of inter-district variations in adolescent pregnancy incidence. Similarly, geographical variations in adolescent pregnancies have been reported across SSA19–22. Additionally, other studies in Ghana (1988–2022) revealed regional disparities in adolescent pregnancy rates, ranging from 6% in the Greater Accra Region to 26% in the Savannah Region16,26. These variations were attributed to socioeconomic, cultural and demographic factors. There is the need for health authorities in high-rate districts to collaborate with relevant stakeholders to organize community durbars and campaigns regarding safe adolescence to help mitigate the occurrence of adolescent pregnancies.

Public health implications for policy and practice

The findings of this study highlight a high incidence of pregnancies among older adolescents, highlighting the need to enhance adolescent-friendly health services. Confidential counselling and contraceptive access should be prioritised across health facilities. Training Community Health Officers in adolescent health competencies is essential to support the integration of sexual and reproductive health services into home visits and community outreach activities.

Geospatial disparities in adolescent pregnancies emphasise the importance of district-specific interventions. Localised strategies such as peer education programs, community durbars, and adolescent health clubs in schools and communities can promote safe adolescence by aligning with local socio-cultural dynamics. It is essential to strengthen the Adolescent Safety Net program in high-rate districts to ensure essential services are provided to pregnant girls.

Addressing adolescent pregnancies requires multifaceted efforts across sectors. Collaboration with the Ghana Education Service, Social Welfare Department, Ghana Police Service, and traditional and religious leaders is crucial to enforcing child protection laws and sexual rights. This partnership is also vital for designing and incorporating comprehensive sexual and reproductive health education into the national school curriculum.

Institutionalising adolescent pregnancy as an indicator within the Holistic Assessment framework of district and regional health performance reviews can enhance the monitoring and evaluation of adolescent health programs. Furthermore, Regional and District Health Directorates should ensure consistent use of the Adolescent Health Register across health facilities to improve adolescent data and support evidence-based decision-making.

Strengths and limitations

This study provides useful insights into the incidence and district variations of adolescent pregnancies in the Volta Region, contributing to the understanding of this public health concern. By leveraging routine health facility data from DHIMS-II, the study offers reliable estimates that can inform policy decisions and guide the development of targeted interventions. However, there are some limitations to consider. The DHIMS-II database only captures limited demographic and obstetric characteristics of pregnant women, restricting the scope of analysis. We could not perform inferential statistics because the DHIMS-II database only captures aggregated data regarding pregnancies. The database also lacks information on a comparison group. Additionally, this study included only pregnant adolescents who sought antenatal care at health facilities in the region, potentially underestimating the true incidence of adolescent pregnancies, as those who did not seek ANC at health facilities were not accounted for. This drawback may affect the generalizability of the findings to the broader adolescent population. Hence, the findings should be interpreted as reflective of facility-based estimates rather than population-level magnitude. Future community-based studies could help determine the actual burden of adolescent pregnancy in the Volta Region. Despite these limitations, the study highlights the relevance of DHIMS-II as a valuable data source for monitoring adolescent pregnancies, informing policy decisions and guiding the design of interventions and strategies to mitigate adolescent pregnancy in the Volta Region.

In summary, this study estimated the incidence of adolescent pregnancies in the Volta Region of Ghana, revealing a general decline in reported adolescent pregnancies over the five years, with a peak in 2021. While the majority of pregnancies occur among older adolescents (15–19 years), the incidence among younger adolescents (10–14 years) remains a critical concern due to the associated health and development risks. These findings underscore the need for targeted interventions addressing the specific vulnerabilities of both younger and older adolescents. The observed district-level variations provide useful information for health authorities to prioritize resource allocation and design context-specific interventions. There is the need to enhance community-based health programs regarding adolescent pregnancy. Local authorities should strengthen the legal frameworks against child marriages to help mitigate adolescent pregnancies in the region. Further research is needed to explore the factors driving inter-district disparities, assess health system preparedness and evaluate the effectiveness of adolescent health programs in reducing adolescent pregnancies in the Volta Region. Also, future studies are important to determine the true burden of adolescent pregnancies and statistically test the spatial and temporal variation in the Volta Region.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary Material 1 (29KB, xls)

Acknowledgements

We are grateful to the Volta Regional Health Directorate for granting administrative permission to access the DHIMS data for this study.

Author contributions

CK, WAA, VZ, SAB and MA conceptualized the study. CK, WAA, VZ, SAB, MA and IA extracted and analyzed the data. CK, WAA, VZ, SAB and MA drafted the manuscript. IA, DK, SKD and FB reviewed the manuscript. All authors read and approved the final manuscript for submission.

Data availability

The datasets used for this study are available online as part of the supplemental materials provided.

Declarations

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Material 1 (29KB, xls)

Data Availability Statement

The datasets used for this study are available online as part of the supplemental materials provided.

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