Determinants of Sexual Activity and Pregnancy among Unmarried Young Women in Urban Kenya: A Cross-Sectional Study

OBJECTIVES With age of marriage rising in Kenya, the period between onset of puberty and first marriage has increased, resulting in higher rates of premarital sexual activity and pregnancy. We assessed the determinants of sexual activity and pregnancy among young unmarried women in urban Kenya. METHODS Baseline data from five urban areas in Kenya (Nairobi, Mombasa, Kisumu, Machakos, and Kakamega) collected in 2010 by the Measurement, Learning & Evaluation project were used. Women aged 15-24 years, who had never been married, and were not living with a male partner at the time of survey (weighted n = 2020) were included. Using weighted, multivariate Cox proportional hazard regression and logistic regression analyses, we assessed factors associated with three outcome measures: time to first sex, time to first pregnancy, and teenage pregnancy. RESULTS One-half of our sample had ever had sex; the mean age at first sex among the sexually-experienced was 17.7 (± 2.6) years. About 15% had ever been pregnant; mean age at first pregnancy was 18.3 (± 2.2) years. Approximately 11% had a teenage pregnancy. Three-quarters (76%) of those who had ever been pregnant (weighted n = 306) reported the pregnancy was unwanted at the time. Having secondary education was associated with a later time to first sex and first pregnancy. In addition, religion, religiosity, and employment status were associated with time to first sex while city of residence, household size, characteristics of household head, family planning knowledge and misconceptions, and early sexual debut were significantly associated with time to first pregnancy. Education, city of residence, household wealth, early sexual debut, and contraceptive use at sexual debut were associated with teenage pregnancy for those 20-24 years. CONCLUSION Understanding risk and protective factors of youth sexual and reproductive health can inform programs to improve young people's long-term potential by avoiding early and unintended pregnancies.