Prevalence and associated factors of Somali teenage pregnancy: a multilevel analysis using the evidence from the demographic and health survey

Background Teenage pregnancy is a major public health concern that contributes to maternal and neonatal morbidity and mortality, particularly in low–income countries. In Somalia, evidence on the prevalence and determinants of teenage pregnancy is limited to a few studies. This study aimed to assess the prevalence of teenage pregnancy among teenagers aged 15–19 years and the factors associated with it. Methods A secondary analysis of the 2020 Somali Demographic and Health Survey (SDHS) was conducted, including 6,608 teenage pregnancies. Descriptive statistics were used to summarise the participant characteristics. Bivariate analyses were used to identify candidate variables ( p 0.20) for multivariable analysis. Multilevel mixed-effects logistic regression was used to examine the individual- and community-level factors associated with teenage pregnancy, with results presented as adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Results The prevalence of teenage pregnancy was 49.49%. In the full multilevel model, individual-level factors significantly In the full multilevel mixed-effects logistic regression model (Model 3), primary education was associated with higher odds of teenage pregnancy (aOR = 1.27, p 0.05), higher education with lower odds (aOR = 0.46, p 0.01), higher wealth quintiles with reduced odds (aOR = 0.71–0.61, p 0.01 to p 0.001), non-intention to use contraceptives with lower odds (aOR = 0.57, p 0.05), and significant regional variations were observed across Somalia compared to Awdal (aOR = 1.41-3.63, p 0.05), while contraceptive use intention categories showed mixed non-significant effects except non-intention which remained significant (aOR = 0.57, p 0.05) are associated with Teenage Pregnancy. Interventions targeting reproductive health education, contraceptive access, and regional sociocultural differences are essential to reduce teenage pregnancies and achieve related Sustainable Development Goals. Conclusion Teenage pregnancy in Somalia is very high (49.49%). It is influenced by education, wealth, contraceptive intentions, and regional differences. Primary education increases risk, while higher education and greater wealth reduce it. Regional disparities are significant, and only the lack of intention to use contraceptives shows a meaningful effect.