Spatial and multilevel analysis of factors associated with teenage pregnancy in Somalia: evidence from the Somali health and demographic survey data

Background Teenage pregnancy is a global public health priority, yet evidence from fragile and post-conflict states remains sparse. In Somalia, adolescent fertility significantly hinders progress toward Sustainable Development Goals (SDGs) 3, 4, and 5. This study aimed to determine the spatial variation and multilevel determinants of teenage pregnancy to provide a geographic roadmap for targeted interventions. Methods We conducted a secondary analysis of the 2020 Somali Health and Demographic Survey (SHDS), utilizing a nationally representative weighted sample of 3,277 adolescent girls (aged 15–19 years). An integrated analytical approach was employed: multilevel mixed-effects logistic regression was used to identify individual and community-level drivers, while spatial autocorrelation (Global Moran’s I, LISA, and Getis-Ord Gᵢ* ) was used to identify localized hotspots and geographic clustering of pregnancy risk. Results The prevalence of teenage pregnancy in Somalia was alarmingly high at 49.49%. Spatial analysis revealed strong, positive spatial autocorrelation (Moran’s I = 0.614, p < 0.001), identifying a significant "Hot Spot" corridor in the South-West (Bay, Gedo, and Bakool regions). Multilevel modeling revealed a "Primary Education Paradox," where teenagers with only primary education faced 27% higher odds of pregnancy (AOR = 1.27; 95% CI: 1.02–1.59) than those with no education, whereas higher education was strongly protective (AOR = 0.46; 95% CI: 0.28–0.76). Additionally, the highest wealth quintile (AOR = 0.61) and reporting "no intention" to use contraceptives (AOR = 0.57, likely reflecting post-conception awareness) were significant predictors. Geographic location emerged as the dominant independent predictor, outweighing urban–rural stratification. Conclusion Teenage pregnancy in Somalia is a full-scale spatial and structural crisis. The concentration of risk in the South-West suggests that regional instability and internal displacement are critical drivers. To meet the targets of the Somali National Transformation Plan (2025–2029), interventions must reach beyond the health sector to include "stay-in-school" incentives that transition girls to secondary education and geographically targeted economic support in high-risk zones.