Adolescent pregnancy has been linked to adverse outcomes for mothers and children. Most studies proposing potential risk pathways for adolescent pregnancy in South Africa are qualitative, hypothesizing links among age-disparate relationships, reduced condom use and higher pregnancy rates. No known South African studies have quantitatively explored pathways to adolescent pregnancy. This study aimed to: i identify which literature-hypothesized factors were associated with adolescent pregnancy and ii explore a hypothesized pathway of risk by assessing whether condom use mediated the relationship between age-disparate sexual relationships defined as having ever had a sexual partner more than 5 years older than participants and adolescent pregnancy. A cross-sectional survey in six urban and rural health districts of three South African provinces. Analyses used multivariate logistic regressions controlling for confounders. Interventions addressing these relationships, facilitating condom use and increasing access to sexual and reproductive health services among adolescent girls might avert unwanted and unplanned adolescent pregnancies. These are further aggravated by low access to non-health services that may alleviate negative outcomes of early pregnancy 4. For example, only a third of adolescent girls that become pregnant in South Africa return to school, with each year that passes after giving birth decreasing the chances of ever returning to school 5.

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