Prevalence and factors associated with having ever impregnated a teenage girl among young men (15-24 years) in Kampala and their early fatherhood experiences

Background Adolescent pregnancy remains a significant public health challenge in sub-Saharan Africa with approximately 7.3 million girls becoming pregnant before the age of 18 annually, a number projected to reach 86 million by 2030. In Uganda, 25% of teenagers become pregnant by age 19, despite declining fertility rates among women aged 15 to 19. The role of young men in adolescent pregnancies remains understudied, with most research focusing on girls. This study assessed the prevalence, associated factors, and lived experiences of early fatherhood among young men (15–24 years) in Kampala, Uganda. Methods A descriptive cross-sectional study design employing mixed methods was conducted among 360 sexually active young men in relationships with adolescent girls in Kampala. Data on sexual behavior, inter-relational factors, and community data were collected using a pre-tested questionnaire uploaded on the Kobo Collect app. In-depth interviews explored the lived experiences of early fatherhood. Poisson regression analysis was used to assess factors associated with ever impregnating an adolescent, while content analysis was used for qualitative data. Results The mean age of participants was 20 (± 2.4) years, and the mean age at first sexual encounter was 15 (± 2) years. The prevalence of ever impregnating an adolescent girl was 45.8% (95%CI: 40.7–51), with 62 (35.6%) of these pregnancies being aborted. The mean age at impregnating an adolescent girl was 17 years (SD 1.6). Factors associated with ever impregnating an adolescent were older age (aPR: 2.09 (1.16 3.75) 2.54(1.43 4.54)), alcohol use (aPR: 1.34 (1.8 1.67)), drug use (aPR: 1.29 (1.04 1.6)), having friends who had ever impregnated an adolescent girl (aPR: 1.73 (1.22 2.45)), and having more than one sexual partner in a year (aPR: 1.54 (1.04 2.3). Qualitative findings revealed four key themes: perception of early fatherhood, support from family and friends, adjustment to fatherhood, and reforming. Conclusion Nearly half of sexually active young men in Kampala have ever impregnated an adolescent girl. Young fathers often face unpreparedness, financial stress, school dropout, and social stigma. Interventions targeting young men, focusing on behavior change, peer education, and reproductive health services, are essential to address adolescent pregnancy effectively.