Prevalence and sociodemographic factors associated with unwanted pregnancy among adolescent girls in Kakuma Refugee Camp, Kenya: a cross-sectional mixed-methods study

ABSTRACT Prevalence and sociodemographic factors associated with unwanted pregnancy among adolescent girls in Kakuma Refugee Camp, Kenya: a cross-sectional mixed-methods study Authors : Benson Simba*1, Louisa Ndunyu1 and Lilian Ogonda2 Globally, an estimated 21 million adolescent girls aged 15-19 years become pregnant annually, with the burden often higher in refugee contexts. Adolescent pregnancy remains an important public health concern, particularly in humanitarian settings. Despite the availability of sexual and reproductive health services in Kakuma Refugee Camp, unwanted pregnancy among adolescent girls persists. According to routine health data from the United Nations High Commissioner for Refugees (UNHCR), 1,079 adolescent pregnancy cases were reported between January 2024 and July 2025 in Kakuma Refugee Camp. However, evidence on the factors associated with unwanted pregnancy among adolescent girls in this multinational refugee setting remains limited. This study estimated the prevalence of unwanted pregnancy and examined socio-demographic factors associated with unwanted pregnancy among adolescent girls in Kakuma Refugee Camp. We conducted a community-based analytical cross-sectional mixed-methods study among 431 adolescent girls aged 12-18 years recruited through multistage cluster sampling. Quantitative data were collected using a pretested structured questionnaire. For the qualitative data, audio-recorded interviews were conducted with four purposively selected health workers as key informants, together with a focus group discussion involving adolescent girls. Quantitative data were analysed using descriptive statistics, chi-square tests, bivariable logistic regression to estimate crude odds ratios (CORs), and multivariable logistic regression to estimate adjusted odds ratios (AORs), with statistical significance set at p [&le;] 0.05. Qualitative data were analysed thematically. The prevalence of unwanted pregnancy was 28.7%. The proportion varied considerably across camp sections, with the highest prevalence observed in Kakuma 2 (56.7%) and Kakuma 4 (54.1%). In adjusted analysis, adolescents aged 12-14 years had lower odds of unwanted pregnancy than those aged 15-18 years, although the association was borderline statistically significant (AOR = 0.348; 95% CI: 0.121-1.000; p = 0.050). Married adolescents had substantially higher adjusted odds of unwanted pregnancy than single/divorced/separated adolescents (AOR = 5.108; 95% CI: 3.065-8.512; p = 0.001), and Christian adolescents had higher adjusted odds than adolescents of other religions (AOR = 3.010; 95% CI: 1.087-8.337; p = 0.034). Compared with Kakuma 4, lower adjusted odds were observed in Kakuma 1 (AOR = 0.168; 95% CI: 0.059-0.483; p < 0.001) and Kakuma 3 (AOR = 0.073; 95% CI: 0.021-0.248; p < 0.001), while Kakuma 2 did not differ significantly. Qualitative findings highlighted older age, being out of school, lower educational attainment, and socioeconomic vulnerability as factors perceived to increase vulnerability to unwanted pregnancy. Unwanted pregnancy remains an important public health concern among adolescent girls in Kakuma Camp. The findings identify marital status, religion, and camp location as important independent correlates, with age showing borderline evidence of an adjusted association. School attendance and education level were associated with unwanted pregnancy in unadjusted analyses but were not independently significant in the adjusted results presented. These findings support context-specific interventions that improve contraceptive access, support school retention, engage married adolescents, and address social and structural vulnerabilities across Kakuma.