Adolescent Pregnancy in Zambia: Dissecting Context to Drive Structural Change, Rights-Based Action, and Youth-Led Solutions
By guest contributors Gift Malunga and Luchuo Engelbert Bain
Adolescent pregnancy in Zambia remains one of the most urgent yet under-addressed public health, development and social justice challenges. Despite years of investment in adolescent sexual and reproductive health (ASRH) interventions and policy commitments, 29% of adolescent girls under the age of 18 experience pregnancy, a figure that has stubbornly persisted over the last decade. With one in five African girls becoming pregnant before 18, Zambia exemplifies systemic neglect. Early pregnancy entrenches cycles of poverty, education exclusion, and maternal risk—necessitating radical multisectoral action. Our research, comparing the Eastern and Southern Provinces across urban and rural settings, reveals that adolescent pregnancy is not merely a health outcome; it reflects deep-rooted structural inequalities, broken systems, harmful social and cultural practices, and persistent access gaps.
If we are to transform adolescent sexual and reproductive health and rights (ASRHR) outcomes, a paradigm shift is urgently needed— moving beyond individual behaviour change to confronting systemic determinants, barriers and structural drivers.
Behind the Numbers: The Real Divide
On the surface, Zambia’s high adolescent pregnancy rates seem to suggest uniform trends across the country, masking critical regional disparities. Adolescent pregnancy rates stand at 37% in rural areas, compared to 17% in urban settings. In rural communities, adolescents’ girls face compounded risks: early/child marriage, harmful cultural practices such as initiation ceremonies, poor access to contraception, limited access to youth-friendly services and acute economic vulnerability.
Early sexual debut—often celebrated or normalized through traditional ceremonies—was identified as a major risk factor. Meanwhile, access to accurate sexual health information and adolescent-friendly services remains alarmingly limited, particularly in rural areas. Urban adolescents, though relatively better served, still grapple with challenges such as peer pressure, inconsistent delivery of sexuality education, and stigma around contraceptive use. Simply expanding services without addressing these underlying social and cultural drivers is insufficient.
Not Just Choices— But Circumstances
Too often, adolescent pregnancy is framed narrowly as a matter of poor decision-making by girls. This narrative ignores the social and constrained unequal structural environments that shape those choices. Despite progressive frameworks, many Zambian adolescents lack access to contraceptives and safe abortion. A rights-based approach must go beyond availability to ensure autonomy, equity, and youth-responsive services.
Guided by the Socio-Ecological Model, our research found that adolescent pregnancy is interconnected by multiple level factors:
- Individual Level: Limited knowledge, early sexual debut, poverty.
- Family Level: Economic pressures-household poverty, lack of parental engagement, harmful norms.
- Community Level: Harmful cultural expectations, stigma, and weak community health service delivery and systems.
- Policy Level: Gaps in enforcing child marriage laws, inadequate investment in adolescent sexual and reproductive health (ASRH).
In other words, adolescents do not make choices in a vacuum—they navigate constrained environments that often fail to protect their rights or enable their aspirations. Respecting their evolving capacities requires ethical, inclusive decision-making frameworks and safe abortion access.
The Missed Opportunity of Current Interventions or Why Current Interventions Fall Short
Despite various ASRH programs, many interventions remain urban-centric, fragmented, and weakly coordinated. Many fail to actively involve adolescents themselves in the design and implementation of solutions. Few interventions address the gender norms, poverty, or legal contradictions that keep girls vulnerable, undermining adolescent agency. Without a deliberate strategy to dismantle these barriers, adolescent girls will continue to carry the burden of a system that was not designed to support their rights or aspirations.
As a result, well-intentioned programs risk reinforcing the very inequities they seek to address.
A New Call to Action: Integrated, Rights-Based, Context-Specific Solutions
Based on this research, we argue for five critical shifts in Zambia’s—and Africa’s—approach to adolescent pregnancy:
- Go Beyond Awareness Campaigns to Structural Interventions
Programs must address poverty, child marriage, harmful traditional practices and lack of access to sexuality education —not just knowledge gaps. - Integrate ASRHR into Broader Development Agendas
Adolescent health cannot be separated from education, social protection, and economic empowerment as part of the SRHR conversation. Cross-sectoral action is vital. - Invest in Adolescent-Centered Service Design
Services must be confidential, stigma-free, affordable, and accessible—especially for rural adolescents. Adolescents themselves should co-design these services. - Enforce and Expand Protective Legal Frameworks
Zambia must strengthen enforcement of laws against child marriage and ensure legal access to comprehensive sexual and reproductive healthcare, including access to contraception and safe abortion services for adolescents. - Challenge and Transform Harmful Gender and Cultural Norms
Community-driven approaches must engage traditional leaders, parents, and young people to challenge practices that perpetuate adolescent pregnancy risk.
From Beneficiaries to Partners: Listening to Adolescents
Perhaps most critically, adolescents themselves must move from being treated as “beneficiaries” to becoming true leaders and decision-makers in programs affecting their lives. During fieldwork, adolescent girls consistently emphasized the importance of having safe spaces to talk, respect, desire for better education, and the frustration of having their realities overlooked in program design. They do not want more top-down lectures; they want to be heard, partnership, trust, inclusivity and real options for their futures.
A Justice Centred Approach
Adolescent pregnancy in Zambia—and across sub-Saharan Africa—is not inevitable. It is the result of policy failure, economic exclusion, gender injustice, cultural neglect, and underinvestment in young people’s futures. If we continue to frame adolescent pregnancy purely as a health problem or a result of poor choices, and moral failure, we will continue to fail a generation. We need a new narrative: one that positions adolescent pregnancy as a justice issue, and demands structural, integrated, adolescent-centered solutions.
Pervasive gender norms, poverty, limited education, and rural-urban disparities intersect to deny adolescents in Zambia equitable SRHR access—deepening risks of early pregnancy, violence, and reproductive injustice. As researchers, practitioners, policymakers, and communities, we must do better—our obligation is not just to work for adolescents, but with them. Their future, and our collective future, depends on it. Empowering youth as co-creators—not mere beneficiaries—of policy is vital for sustainable, equitable reproductive justice.
About the authors:
Dr. Gift Malunga is a seasoned leader within the United Nations Population Fund (UNFPA), with an extensive track record of advancing gender equality, adolescent sexual and reproductive health, and youth empowerment across multiple African countries. She currently serves as the UNFPA Country Representative in Uganda, where she continues to champion rights-based, inclusive approaches to health and development.
Dr. Luchuo Engelbert Bain is a global health physician and bioethicist with over 15 years of experience shaping health research, policy, and practice across Africa. He leads international programs at the African Population and Health Research Center (APHRC) in Nairobi, Kenya, and has published widely on adolescent sexual and reproductive health and rights. His current interests focus on decolonizing global health—addressing power imbalances in knowledge production, leadership, and funding—while advancing health diplomacy, strategic science communication, and systems strengthening for equitable health outcomes.
