The Remarkable 16% Drop in Teen Pregnancies Nationwide
South Africa has witnessed a significant and unexpected turnaround in adolescent pregnancy rates, with a 16% decline recorded across all nine provinces from April 2021 to March 2025. This striking reversal comes from new research published in the South African Medical Journal (SAMJ), analyzing public sector data on deliveries and terminations of pregnancy. The study marks the first comprehensive baseline using both births and terminations, providing a clearer picture of the true scope of adolescent pregnancies among girls aged 10 to 19.
In 2025, the national adolescent pregnancy rate for girls aged 15 to 19 stood at 48.9 per 1,000, down from higher figures in previous years. For the youngest group, girls aged 10 to 14, the rate fell to 1.2 per 1,000—a nearly 40% drop in births alone. This consistent year-on-year decrease bucks a troubling upward trend seen from 2017 to 2021, when rates were climbing in every province.
The data, drawn from the District Health Information System (DHIS), covers public facilities where over 90% of deliveries occur. While private sector and home births are not included, the trends are robust and verified through multiple checks, leaving researchers both encouraged and puzzled.
Provincial Variations: Rural Areas Lead the Way
Every province showed declines, but the magnitude varied, with rural areas experiencing steeper drops. For instance, North West saw a 24.4% reduction in births among 15-19-year-olds, while Limpopo and Eastern Cape followed closely with around 24-25% decreases. Urban hubs like Gauteng (9.4% drop) and Western Cape had more modest declines but higher termination of pregnancy (TOP) rates, reflecting better access to services.
Northern Cape's pregnancy rate for 15-19-year-olds was 61 per 1,000 in 2025, the highest, compared to Gauteng's 38 per 1,000. This urban-rural divide highlights disparities in healthcare access, family planning, and socioeconomic factors. Termination rates surged 17.6% nationally for 15-19-year-olds, up to 30% in some urban provinces, suggesting more girls are seeking and obtaining services where available.
| Province | Key Decline Notes (15-19 births) |
|---|---|
| Eastern Cape | ~25% drop, high rural impact |
| Limpopo | 24% decline |
| North West | 24.4% reduction |
| Gauteng | 9.4% drop, higher TOPs |
| Western Cape | Modest decline, urban TOP access |
These patterns underscore the need for targeted rural interventions, as younger pregnancies (10-14) dropped 39.8% nationally, often linked to coercion or violence.
Reversing a Decade-Long Upward Trend
Prior to 2021, adolescent birth rates were rising, with a 2022 SAMJ analysis showing increases across provinces from 2017-2021. Births to 10-14-year-olds rose 48.7%, a red flag for statutory rape cases. The new data flips this script, with total public sector births falling 20% overall, faster for adults than teens.
South Africa's rate remains high—over five times high-income countries' average—but lower than sub-Saharan Africa's 93.4 per 1,000 (2019). One in 24 girls aged 15-19 gave birth in 2024/25, down from previous highs.
Spotlight on the Youngest Victims: Ages 10-14
The most dramatic shift is among girls 10-14, where births plummeted 39.8%, from 3,963 in 2022 to 2,387 in 2025. Pregnancy rates halved in some areas. These cases often involve sexual violence, making the decline 'very pleasing' per researcher Peter Barron.
Terminations for this group showed mixed results, with urban increases but rural decreases, pointing to access barriers like clinic closures and conscientious objection.
Urban Access vs Rural Challenges
Urban provinces like Gauteng and Western Cape have higher TOP rates (e.g., 40%+ increases), enabling more pregnancies to end safely. Rural areas rely more on births due to limited services, but saw bigger birth drops—possibly from cultural shifts or economic pressures.
This disparity calls for mobile clinics and training more providers in underserved areas.
Photo by Marija Zaric on Unsplash
Unraveling the Mystery: Why the Drop?
Researchers are stumped. Lead author Peter Barron called it 'the elephant in the room,' after consulting demographers. No single factor explains the uniform decline.
The SAMJ study speculates post-COVID effects (lockdowns reducing risky behavior), urbanization (68.8% urban in 2023), fertility declines across ages, or subtle policy gains like better sex education and contraception. High living costs may delay family formation. However, US funding cuts reduced condom distribution, potentially counteracting gains. Rising STIs suggest inconsistent protection.
More research is needed; 2026 data will clarify if sustainable.
Expert Insights and Cautious Optimism
'When you see 5-10% drops year on year, alarms go off,' Barron told Bhekisisa. Data was triple-checked. Experts like Lesley Bamford (DoH) praise rural gains but stress coordination.
WHO's 2025 guidelines urge multisectoral action: end child marriage, combat violence, expand education and contraception. SA policies exist but need a national strategy.
Societal and Economic Ripple Effects
Lower rates ease education burdens (fewer dropouts), reduce maternal risks, and slow population growth amid housing shortages. Smaller cohorts mean better resourced schools long-term.
Yet, teen mothers face poverty cycles; their children have poorer outcomes. Economically, fewer births curb welfare costs but raise ageing population concerns.
Persistent Challenges and High Stakes
Rates are still elevated (48.9/1,000 vs. global highs 9/1,000). Rural access lags; violence persists. STIs rise; new PrEP like lenacapavir doesn't prevent pregnancy. Funding gaps threaten condoms, key for dual protection.
Bhekisisa reports integrated data systems are vital for tracking.
Government Response and Policy Path Forward
SA has frameworks like the National Adolescent Sexual and Reproductive Health Rights Framework. DoH pushes annual reporting. Experts urge a national strategy with community norms shift, school programs, and rural services.
Photo by Hakim Menikh on Unsplash
- Enhance TOP access equitably
- Boost contraception distribution
- Integrate sex ed in curricula
- Address violence via GBV programs
- Monitor via unified data
Looking Ahead: Sustaining Momentum
If 2026 data confirms, celebrate progress. But vigilance needed—rates high, disparities exist. Multisectoral efforts can build on this, empowering girls for brighter futures. Stakeholders must coordinate to uncover drivers and amplify successes.
Daily Maverick analysis stresses policy alignment with WHO.
