Service delivery inaccessibility as a predictor of teenage pregnancy in South Africa

Background: With the onset of the South African democracy in 1994 it was hoped that many social inequalities would beaddressed urgently. However, studies have shown that service delivery inaccessibility remains a challenge and investigating thesocial implications of such injustices remains important. Objective: This study determined to establish the association between service delivery inaccessibility and adolescent pregnancyin South Africa. Methods: Using data from 2019 and 2021 general household surveys, 7 737 teenage females were included. The study applieddescriptive statistics, chi-squared testing as well as multilevel binary logistic regression. Results: Random-intercept multilevel binary logistic regression revealed that the risk of adolescent pregnancy independently increased as the level of service inaccessibility increased at household level (no services: OR=1.73, 1 service: OR=1.40, 2 services:OR=1.28) and community level (medium: OR=1.22, high: OR=1.38) at a P-value of 0.05. Conclusion: Findings highlight the need to guarantee universal service delivery urgently not only for development, but also toprevent adolescent pregnancy. Furthermore, the findings present evidence of structural factors driving adolescent pregnancy inSouth Africa, which renders continued cycles of poverty, injustice and early pregnancy amongst the majority of Blacks. Keywords: Teenage pregnancy; service inaccessibility; multilevel modelling; South Africa; structural inequality; teenagers.