Adolescent pregnancy is a major public health priority in Southeast Asia, including Indonesia. However, little is known about girls’ pathways to adolescent pregnancy, particularly those that occur outside of marriage or cohabitation. Working with the Burnet Institute, in 2020 Empatika conducted a study to understand the drivers and pathways to adolescent pregnancy in Indonesia. Our team worked with young women and adolescent girls aged 16-20 years who had experienced pregnancy at age 18 or younger using timeline visuals, which were created and discussed during in-depth interviews with study participants.

Following the first phase and discussions with Burnet on the initial insights,  our team developed short, Tiktok-style multimedia videos  which our researchers used as prompts for follow-up consultations with a selection of the study participants to explore policy and programming recommendations related to adolescent pregnancy. 

It is hoped that findings from this study will help inform interventions that enables girls to make informed decisions for their relationships and life trajectories.

The study insights also helped support a follow-up pilot project with Burnet, which tested an online survey tool for improving data and understanding about early marriage in Indonesia

Some of the key insights included:

• We identified six distinct pathways to early pregnancy. The pathways were broadly differentiated by the timing of conception relative to marriage. Pathways were further differentiated based on the dominant motivation for marriage – some were married for economic reasons, some marriages were initiated by the couple wanting to progress their relationship, while others were married at the urging of parents to protect their reputation.

• In the further three pathways, participants conceived before marriage (premarital conception), with pathways diverging around the nature of sexual relationship that participants had with the father of their baby prior to pregnancy, including consensual sex, unwanted or pressured sex, and forced sex.

• Couples typically faced strong social pressure to conceive shortly after marriage, and thus, contraceptives were rarely used. 

• Across pathways, key determinants of young women’s pathways to adolescent pregnancy included a lack of knowledge about sexual and reproductive health, barriers to contraceptive access and use (including shame and stigma), constraints on girls’ agency and decision-making power, sexual violence, and sexual double standards. 

• Recommendations from the study, which were also explored during follow-up interviews with some of the participants, included: (1) use interpersonal and informal approaches to sexuality education; (2) engage girls’ mothers and friends, use real-life experiences and scenarios; (3)  use social media to disseminate information about SRH; (4) teach girls about puberty, menstrual health, sex, pregnancy, contraception and sexual violence; (5) provide girls with counselling; (5) teach parents and especially boys to respect girls decision; (6) make contraceptives available in online and private spaces; (7) provide support to girls who experience forced sex or rape.