Barriers and Enablers of Adolescent Sexual and Reproductive Health Outcomes: A Case-Control Study in Rwanda

Background Teenage pregnancy remains a global health concern, with Rwanda experiencing an increase due to limited contraception knowledge, economic constraints, family conflicts, and limited access to healthcare, despite efforts to promote girls' education. Methods This study examined risk factors for teenage pregnancy among adolescents aged 15 to 19 using a case-control design in high-prevalence districts. Teen mothers and pregnant adolescents were compared with their non-pregnant peers. Statistical analyses, including conditional multivariable logistic regression, identified significant risk factors. Results The median age of participants was 18 years (IQR = 1.0), with 46.3% aged 18. Pregnant adolescents were more likely to have incomplete primary education (40.7% vs. 19.5%) and be currently studying (83.3% vs. 49.1%) than their non-pregnant counterparts. Protective factors included health facility visits for sexual and reproductive health (SRH) services (AOR = 0.16, 95%CI: 0.07–0.41, p  < 0.001), and comfort in asking parents ASRH questions (AOR = 0.33, 95%CI: 0.11–0.95, p = 0.039). In contrast, not being enrolled in school (AOR = 8.22, 95%CI: 2.98–22.69, p  < 0.001) significantly increased the likelihood of pregnancy. Conclusion The rising rates of teenage pregnancy in Rwanda highlight the urgent need for policies supporting school retention and comprehensive SRH education. Strengthening parental communication, expanding adolescent-friendly SRH services, and implementing community-based interventions are essential in addressing teenage pregnancy. Additionally, psychosocial support and economic empowerment programs for young mothers can mitigate their long-term impacts.