What do 20 years of national data tell us about teenage pregnancy in Malawi?

Background: Malawi has one of the highest burdens of teenage pregnancy in Eastern and Southern Africa. National prevalence of teenage childbearing declined from 34.1% in 2004 to 25.6% in 2010, then rose to 29.0% in 2015-16. Using the newly released 2024 Malawi Demographic and Health Survey (MDHS), I tested whether this earlier decline has since stalled, and whether trends have been shared equally across social groups, questions that bear directly on the youth targets of Malawi 2063’s First 10-Year Implementation Plan (MIP-1).Methods: Data on 17,130 girls aged 15 to 19 were pooled from four MDHS rounds (2004, 2010, 2015-16, and 2024). The outcome, begun childbearing, was defined identically in every round as having had a live birth or being pregnant with a first child. Design-based prevalence and annual rates of change between rounds were estimated, and survey-weighted logistic regression was used to test whether the 2024 level differed from 2015-16, before and after adjusting for age, residence, region, education, and wealth. Subgroup differences in trends were tested with interaction terms.Results: The proportion of girls aged 15 to 19 who had begun childbearing fell from 34.1% in 2004 to 25.6% in 2010, rose again to 29.0% by 2015-16, and remained essentially unchanged at 30.1% in 2024 (odds ratio versus 2015-16: 1.05, 95% CI 0.94 to 1.18, p=0.394). Adjustment for population composition did not alter this conclusion. Trends differed by wealth (interaction p=0.009): prevalence among the poorest fifth of girls climbed from 31.1% in 2010 to 46.3% in 2024, while it stayed near 15% among the richest fifth, roughly doubling the poorest-to-richest gap to about 31 percentage points.Conclusion: Malawi has made no national progress on teenage pregnancy since 2010, and the burden is increasingly concentrated among the poorest, rural girls. Meeting MIP-1’s youth targets will require equity-focused action rather than business as usual: protecting poor girls’ secondary schooling, enforcing the ban on child marriage, and making contraception genuinely accessible to adolescents.