Transactional sex and intersecting vulnerabilities: a multicountry cross-sectional study of pregnant and parenting adolescents in sub-Saharan Africa

Introduction Transactional sex among adolescents in sub-Saharan Africa is well documented, with extensive scholarship describing its meanings, drivers and implications. However, pregnant and parenting adolescent girls remain comparatively under-represented in this literature, despite facing unique forms of socioeconomic and relational vulnerability. Grounded in the socioecological model, this study examines the prevalence and correlates of transactional sex among pregnant and parenting adolescent girls aged 12–19 in Ouagadougou (Burkina Faso), Nairobi (Kenya) and Blantyre (Malawi).Methods We analysed cross-sectional survey data collected between March 2021 and December 2022 from 980 participants in Burkina Faso, 594 in Kenya and 669 in Malawi. Transactional sex was measured through self-reports of exchanging sex for basic needs, including food, shelter, school fees, sanitary products and other necessities. Unadjusted and adjusted modified Poisson regressions were used to examine associations across individual, interpersonal and community levels.Results Transactional sex was reported by 44.3% of participants in Kenya, 25.4% in Burkina Faso and 13.0% in Malawi. Being single increased the odds compared with being married (adjusted odds ratio (AOR): 1.87 in Burkina Faso; 1.61 in Kenya; 2.11 in Malawi). Substance use was associated with transactional sex in Burkina Faso (AOR: 2.06), but not in the other countries. In Burkina Faso, girls with secondary education had higher odds than those with primary education (AOR: 1.34). Orphanhood was associated with transactional sex in Kenya (AOR: 1.43) and Malawi (AOR: 1.95), but not in Burkina Faso. In Malawi, lack of parental support was strongly associated with transactional sex (AOR: 2.64), while no association was found in the other countries. At the community level, perceived neighbourhood safety was protective in Kenya (AOR: 0.92) and Burkina Faso (AOR: 0.90).Conclusions Transactional sex among pregnant and parenting adolescents is influenced by complex, context-specific factors. Interventions should address individual risks, strengthen family and community support, and improve neighbourhood safety to reduce vulnerability.