Declining adolescent pregnancies in South Africa: Insights from public sector data, 2021 - 2025

Researchers: P Barron, N Lince-Deroche, L Bamford, H Subedar, T Mbatha and Y Pillay.

March 2026

What Is The Study About?

In South Africa (SA), adolescent pregnancy, particularly in very young girls, is an issue of keen public and political concern given its social and health implications. This study provides a quantitative baseline that SA can use for targeting its efforts to address adolescent pregnancy and for measuring progress over time.

Why Is This Important?

Barron’s previous study in 2022, showed that adolescent pregnancies were rising continuously across all nine provinces. Public health leaders and policymakers had been operating under the assumption that the crisis was worsening. This study reveals that the trend flipped into a sharp, multi-year decline across the entire country, completely changing the baseline data used for public health planning.

The most striking finding was the ~40% drop in births among girls aged 10 to 14. Because pregnancies in this age group almost universally involve coercion, exploitation, or statutory rape, this steep decline suggests a major reduction in the severe social and legal harms affecting very young girls, providing crucial data for child protection agencies.

Additionally, a study like this is essential for national budgeting and social planning, as well as creating a snapshot of the public health system impact. Adolescent pregnancy is one of the single largest drivers of early school dropouts among young women. When teenage birth rates fall, school completion rates rise, improving long-term economic mobility, employment prospects, and financial independence for women.

What We Know…

The National Department of Health data indicated a sharp rise in teenage deliveries during and immediately following the COVID-19 lockdowns (2020–2021). Extended school closures, economic displacement, disrupted access to primary health clinics, and heightened exposure to gender-based violence (GBV) inside homes were recognised as major drivers of this spike. High-profile national data releases in 2021 and 2022 revealed that tens of thousands of deliveries occurred among girls under 18 and thousands among those aged 10 to 14. Because pregnancies under age 16 legally constitute statutory rape, this triggered intense national outrage and led to urgent parliamentary debates.

Adolescent mothers (under 20) consistently accounted for roughly 12% to 14% of all public sector hospital deliveries across South Africa. Long-term historical data showed that rural provinces, particularly the Eastern Cape, KwaZulu-Natal, and Mpumalanga, consistently recorded higher proportions of adolescent births compared to urbanised provinces like Gauteng and the Western Cape.

Before the new findings, researchers and policymakers operated on a well-documented framework of root causes. Youth frequently reported experiencing stigma, judgmental attitudes, and a lack of privacy from health workers at local public clinics, deterring them from seeking family planning services. Poverty and high unemployment made young women vulnerable to transactional relationships with older men, driving high rates of non-consensual or coercive sexual encounters. Despite national Life Orientation curricula in schools, implementation varied wildly, leaving many adolescents without comprehensive reproductive health literacy. Widespread sexual assault and statutory rape remained primary structural drivers, especially for children under 15.

What Was Discovered…

Using public sector service data for deliveries and terminations of pregnancies, we estimated adolescent pregnancy rates among adolescent girls aged 10 - 14 and 15 - 19 years for the financial years 2021/22 - 2024/25.

In 2025, the adolescent pregnancy rate (including births and terminations) for 15 - 19-year-olds was 48.9 per 1 000. For 10 - 14-year-olds, it was 1.2 per 1 000. Both the total number of births and the adolescent pregnancy rates dropped annually over the 4-year period of review, and reversed the previous trend of increases from 2017/18 through to 2020/21. Although there were decreases in births and adolescent pregnancy rates in all provinces, there were greater decreases in the more rural provinces compared with the more urban provinces (e.g. Western Cape and Gauteng). Termination of pregnancy rates were also higher in more urban provinces.

In summary, between April 2021 and March 2025, adolescent birth rates across South Africa's nine provinces dropped by 16%. Births among girls aged 10 to 14 saw the steepest decline—falling by nearly 40%. Researchers highlighted this drop as especially critical, as pregnancies in this age group almost universally constitute statutory rape. Total annual births among girls aged 10 to 19 decreased from over 135,000 to roughly 114,800. Rural provinces (such as the Free State, North West, and Mpumalanga) recorded larger drops compared to urban provinces like Gauteng and the Western Cape.

The study, surprised demographers because year-on-year drops of 5% to 10% typically indicate major systematic changes, yet no single intervention explains the trend. Total births across South Africa fell by roughly 20% overall during the same timeframe, indicating that the teenage drop is part of a larger national fertility shift. While termination of pregnancy (TOP) rates were higher in urban centres, researchers confirmed that a drop in overall birth rates, rather than a surge in abortions, was the primary driver. Factors like post-pandemic economic pressure, shifts in social behaviour, and changes in access to contraception are suspected, but demographic modellers have not identified a definitive single cause.

The Future/ Possible Solutions…

While SA already has a strong policy framework for addressing adolescent pregnancy, there is a need for a national strategy and improved co-ordination of efforts. Indeed, the updated 2025 World Health Organization guidelines on preventing adolescent pregnancy and mitigating its adverse impacts highlight the need for a broad, multisectoral approach.

Despite the positive trajectory, South Africa’s adolescent pregnancy rate remains more than five times higher than the high-income country benchmark.