Pathways to Adolescent Pregnancy in Southeast Asia: Qualitative Evidence From Lived Experiences of Girls in Four Countries

Historically, adolescent pregnancy has been conceptualized as an outcome of child marriage, but in Southeast Asia, the contexts and drivers of adolescent pregnancy are less well-understood. This study examines the relationship between adolescent pregnancy and child marriage and explores the drivers of pregnancy in Cambodia, Indonesia, Lao People's Democratic Republic and Malaysia among adolescents who have experienced pregnancy. Using participatory timeline interviews, we conducted semistructured interviews with 260 adolescent girls aged 15-21 years with lived experience of pregnancy in urban and rural settings in Cambodia, Indonesia, Lao People's Democratic Republic and Malaysia. Data were analyzed using an inductive framework approach to allow within and cross-case analysis and map girls' pathways to pregnancy. We found diverse pathways to adolescent pregnancy occurring outside and within unions. Pathways diverged according to nature of sexual experience leading to pregnancy (consensual, pressured, forced), girls' relationships (romantic or not), pregnancy intention (unintended, partner-led and intended), and union initiation (peer-, partner- or parent-led, or no union). Common drivers of pregnancy included lack of sexual and reproductive health information, low contraceptive use, girls' limited agency in sexual and contraceptive decision-making, and limited access to health services, alongside community acceptance of child marriage. Adolescent girls' lived experiences highlight key and differing points in their pathways to pregnancy where there are opportunities for policies and programs to address girls' specific needs and contexts.