Associations between lifetime pregnancy and sexual risk behaviors among 15-24-year-old adolescent girls and young women in South Africa: Secondary analyses of the 2016 Demographic Health Survey

Adolescent girls and young women (AGYW) in South Africa are highly vulnerable to HIV and poor sexual and reproductive health (SRH) outcomes. Interventions must respond to the unique needs of different AGYW groups, such as AGYW who have ever been pregnant. The objective of the study is to examine associations between pregnancy and sexual risk behaviors among AGYW in South Africa. This study used the 2016 nationally representative Demographic and Health Survey (DHS) of South Africa (n = 1935, 15–24 years old). Sexual risk behavior outcomes included: early sexual debut (defined as having sexual intercourse before the age of 15 years), age-disparate relationship (defined as having sexual partners who are five years and older in the past one month), multiple sexual partnerships, no condom use at last sex, and lastly, cumulative sexual risk (defined as reporting at least two of the outcomes: early sexual debut, age-disparate relationship, multiple sexual partners, and no condom use at last sex). Data analyses were conducted using logistic regression in STATA version 16. Statistical significance was determined at a P-value less than 0.05, with 95% confidence interval reported. AGYW who experienced lifetime pregnancy were more likely to report early sexual debut (OR = 1.71, 95%CI = 1.30–2.32), age-disparate relationships (OR = 1.58, 95%CI = 1.20–2.08), no condom use at last sex (OR = 2.77, 95%CI = 2.09–3.69), and cumulative sexual risk (OR = 1.82, 95%CI = 1.38–2.41). Multiple sexual partnerships showed no significant associations with lifetime pregnancy. Married or cohabiting AGYW were more likely to report cumulative sexual risk behaviors. (OR = 2.67, 95%CI = 1.91–3.71). Cumulative sexual risk behaviors were lower among AGYW with secondary education (OR = 0.57, 95%CI = 0.33–0.99) and those from rich households (OR = 0.62, 95%CI = 0.43–0.88). The findings underscore the need for interventions promoting safe sex and relationships, especially among AGYW who have experienced pregnancy. Programming should address the structural, socio-economic drivers of early pregnancy.