Background and objective:
Adolescent pregnancy is an important health indicator of the Sustainable Development Goals. In South Asia about one in five adolescent girls give birth before the age of 18 and in India, nine percent of 15-19 years old girls become pregnant each year. The aim of this study was to investigate the demographic, behavioural, social and external factors associated with adolescent pregnancy among girls aged 13–18 years in the state of Maharashtra, India.

Methods:
Primary data from a cross-sectional study with adolescent girls aged 13 – 18 years in two regions in Maharashtra: around the city of Pune and rural villages of Sangli district was analysed. Quantitative data were collected face to face by trained local enumerators, and qualitative data were collected from seven in-depth interviews. Data analyses were done using StataMP 17 for descriptive, bivariate and multivariable logistic regression analyses.

Results:
The final analysis was undertaken for 3049 respondents. At bivariable analysis, all variables except for participant’s higher secondary education were significantly associated with adolescent pregnancy. The final model in the multivariable analysis showed that participant’s age, marital status, number of sexual partners and COVID-19 related economic vulnerability increases the likelihood of adolescent pregnancy. Furthermore, predictors including residence in a rural location, participant’s education, female sibling and mother’s education decreases the likelihood of adolescent pregnancy. Thematic analysis of qualitative data revealed four potential channels linked with adolescent pregnancy: i) economic hardships and early marriage, ii) safety, social norms and early marriage, iii) social expectations and iv) lack of knowledge on contraceptives.

Conclusion:
Demographic factors including age, place of residence, participant’s education, mother’s education, marital status and female sibling, behavioural factor including number of sexual partners and external factor including COVID-19 economic impact are important predictors of adolescent pregnancy in Maharashtra, India in the aftermath of COVID-19 pandemic.