Teenage pregnancy remains a pressing global public health issue, with profound implications for the health, education, and socio-economic well-being of young women. Defined as pregnancy occurring in girls aged 19 years or younger, early childbearing is often associated with a cascade of adverse outcomes including maternal and neonatal health risks, educational discontinuation, and entrenched cycles of poverty. According to the World Health Organization, complications during pregnancy and childbirth are among the leading causes of death for girls aged 15–19 years worldwide, emphasizing the urgency of addressing this multifaceted problem. In developing countries like India, teenage pregnancy continues to be fueled by a combination     of      socio-cultural       factors,     gender inequities, limited access to reproductive health services, and gaps in community-level awareness [1-4].

In the context of Himachal Pradesh, a predominantly rural and semi-urban state in northern India, teenage pregnancy poses unique challenges. Traditional social norms, early marriages, limited sexual and reproductive health education, and stigma surrounding contraceptive use contribute significantly to the persistence of early pregnancies. Despite improvements in literacy and healthcare infrastructure, many young girls in the region continue to face societal pressures that prioritize early marriage and motherhood over education and personal development. As a result, educational attainment among teenage mothers often suffers, leading to increased dropout rates and curtailed career opportunities, thereby perpetuating gender disparities and economic dependency [5,6].

Health risks associated with teenage pregnancy are numerous and severe. Adolescents are biologically less prepared for childbirth, facing higher risks of complications such as anemia, hypertensive disorders, obstructed labor, and low birth weight infants. Psychological distress, postpartum depression, and social marginalization further compound the challenges faced by young mothers. These risks are exacerbated by inadequate prenatal care, lack of nutritional support, and limited postnatal follow-up, particularly in resource-constrained settings [7,8].

Understanding community awareness, perceptions, and attitudes toward teenage pregnancy is crucial for designing effective interventions aimed at prevention and support. Empowering young women with comprehensive sexual education, promoting delayed marriage, ensuring access to contraceptive services, and fostering supportive community environments can significantly reduce the incidence and consequences of teenage pregnancy.

This study aims to explore the level of community awareness regarding teenage pregnancy in Himachal Pradesh, examine its perceived impacts on women's health and education, and identify key barriers to prevention. By highlighting existing knowledge gaps and socio-cultural dynamics, the research seeks to inform targeted public health strategies and educational campaigns that prioritize the health, rights, and futures of young women.

Study Design

A descriptive, cross-sectional, community-based online survey was conducted to assess awareness, perceptions, and attitudes regarding teenage pregnancy and its impact on women’s health and education in Himachal Pradesh. This design was selected to efficiently capture a broad range of insights from diverse population groups across the state.

Study Area and Population

The study was conducted among residents of Himachal Pradesh, targeting individuals aged 18 years and above. Participants included parents, teachers, healthcare workers, and community members from both rural and semi-urban settings to ensure a comprehensive understanding of community-level awareness. Women and men from various educational and socio-economic backgrounds were invited to participate.

Study Duration

Data collection was carried out over a period of three months, from January to March 2025

Sample Size and Sampling Technique

Assuming a 50% awareness level about teenage pregnancy issues (due to limited prior data in the region), a 95% confidence interval, and a 5% margin of error, the minimum required sample size was calculated to be 384 participants. To accommodate incomplete or invalid responses, a final target of 420 completed responses was established.

A convenience sampling method was adopted. The survey link was distributed through social media platforms (WhatsApp, Facebook, Instagram), local educational institution mailing lists, healthcare centers, women’s self-help groups, and community outreach volunteers to maximize participation across various demographics.

Inclusion and Exclusion Criteria

Inclusion Criteria:

• Residents of Himachal Pradesh aged 18 years and above.

• Ability to read and comprehend Hindi or English.

• Voluntary provision of informed electronic consent.

Exclusion Criteria:

• Individuals unwilling to participate or unable to complete the online questionnaire.

• Duplicate responses identified through device ID and IP address monitoring.

Data Collection Instrument

A structured, bilingual (Hindi and English) and pre-validated questionnaire was developed and administered through Google Forms. The questionnaire consisted of four major sections:

• Socio-Demographic Information: Age, gender, education level, occupation, marital status, and place of residence (urban/rural/semi-urban).

• Awareness of Teenage Pregnancy: Knowledge about causes, health risks, educational impacts, and preventive measures.

• Community Perceptions and Attitudes: Cultural beliefs, societal norms, and openness to adolescent reproductive health education.

• Prevention Strategies: Awareness of available services (such as family planning, school counseling) and personal views on effective prevention methods.

The questionnaire was initially pilot-tested among 30 individuals from diverse backgrounds (excluded from the final sample) to assess its clarity, relevance, and cultural appropriateness. Necessary revisions were made based on feedback.

Data Collection Procedure

Upon accessing the survey link, participants were directed to an introductory page explaining the study’s objectives, emphasizing confidentiality, voluntary participation, and the absence of any personally identifiable data collection. Electronic informed consent was mandatory to proceed with the survey.

Participation was anonymous, and settings within Google Forms restricted multiple entries from a single device. Participants were encouraged to complete the survey independently and without external influence to maintain response authenticity.

Scoring and Categorization

Responses to knowledge-based questions were scored as follows:

• Correct Response: 1 point.

• Incorrect or "Don’t Know" Response: 0 points.

• Cumulative scores were classified into four awareness categories:

• Very Good Awareness: ≥80% correct answers.

• Good Awareness: 60%–79% correct answers.

• Fair Awareness: 40%–59% correct answers.

• Poor Awareness: <40% correct answers.

Separate sub-domain scores were calculated for knowledge of health risks, educational consequences, and awareness of prevention strategies.

Data Analysis

Data were exported from Google Forms into Microsoft Excel and analyzed using IBM SPSS Statistics Version 26.0. Descriptive statistics (frequencies, percentages, means, and standard deviations) were used to summarize socio-demographic characteristics, awareness levels, and community perceptions. 

Ethical Considerations

The study was conducted in accordance with the ethical standards outlined in the Declaration of Helsinki. Participation was entirely voluntary, and participants were informed about the purpose of the study, confidentiality measures, and their right to withdraw at any point.

The socio-demographic profile of the 420 participants in this study reflects a diverse and representative sample of the community across Himachal Pradesh. The largest age group consisted of individuals aged 18–30 years (41.4%), followed by those aged 31–40 years (32.4%), 41–50 years (18.6%), and above 50 years (7.6%). Females comprised a slight majority (57.6%), while males accounted for 42.4% of respondents. Educational attainment was varied, with 35.2% having completed secondary education, 33.1% holding undergraduate degrees, 11.7% possessing postgraduate qualifications, and 20% reporting either primary school education (13.8%) or no formal education (6.2%). In terms of occupation, 28.8% were homemakers, 20.7% worked in the private sector, 19.5% were self-employed, 15.0% were government employees, and 16.0% were unemployed or engaged in other informal sectors. Geographically, a majority of participants resided in rural areas (61.4%), with the remaining 38.6% belonging to semi-urban settings, offering valuable insights into the rural-urban divide in awareness levels regarding teenage pregnancy.

The analysis of awareness and knowledge related to teenage pregnancy and its impacts revealed a generally positive trend among participants, although notable gaps remain. A significant majority (83.1%) correctly defined teenage pregnancy as pregnancy occurring before age 20, and 80.0% recognized the heightened risk of maternal anemia associated with early pregnancies. Awareness regarding the linkage between early pregnancies and neonatal mortality (75.7%), school dropout rates (83.8%), and the contribution of early marriage to teenage pregnancy (86.4%) was commendably high. Additionally, 81.2% understood that lack of contraception access elevates teenage pregnancy risk, while 84.3% supported the necessity of mandatory sex education in schools. However, only 68.3% correctly identified that improved immunity is not a health risk of teenage pregnancy, suggesting persistent misconceptions in specific health domains. Encouragingly, the majority recognized the critical role of family planning services (78.8%), delayed marriage (80.7%), and community awareness (81.7%) in prevention, and overwhelmingly rejected the myth that teenage pregnancy stems from moral failings (80.5%), signaling a shift toward more informed and progressive community perspectives.

Table 1: Socio-Demographic Characteristics of Participants

Table 2: Awareness and Knowledge of Teenage Pregnancy and Its Impact Among Participants

Table 3: Knowledge Score Classification

Knowledge score classification further elucidated the distribution of awareness levels among the participants. Nearly half of the respondents (49.8%) demonstrated a "Good" level of knowledge, correctly answering 60%–79% of the questions. A promising 25.0% of participants achieved a "Very Good" awareness score (≥80% correct answers), reflecting a substantial foundation of understanding among a significant segment of the community. However, 18.1% of participants exhibited only "Fair" knowledge (40%–59%), and 7.1% fell into the "Poor" category, highlighting the critical need for focused educational interventions. These findings suggest that although community knowledge on teenage pregnancy is improving, particularly in terms of recognizing health risks and the importance of preventive measures, significant informational gaps persist that must be addressed through targeted, culturally sensitive health promotion efforts.

This study offers valuable insights into community awareness, perceptions, and knowledge regarding teenage pregnancy and its impacts on young women’s health and education in Himachal Pradesh. The findings reveal a complex but encouraging landscape, where fundamental awareness is relatively widespread, yet critical gaps persist—particularly in understanding the deeper health consequences, socio-economic effects, and preventive strategies surrounding teenage pregnancies.

The socio-demographic characteristics of the participants reflect a diverse and representative sample, with a predominance of rural residents (61.4%) and a majority of women (57.6%). The educational distribution—where nearly 68.3% had attained at least secondary education—suggests that educational improvements have begun to penetrate various sectors of Himachal Pradesh's population. Yet, despite this promising educational background, awareness about teenage pregnancy, although reasonably high in basic aspects, is still insufficient in several important domains, highlighting the gap between general education and targeted reproductive health literacy.

Encouragingly, a majority of participants (83.1%) correctly identified teenage pregnancy as pregnancy occurring before the age of 20, and large proportions acknowledged major consequences, such as increased maternal anemia (80.0%), neonatal mortality (75.7%), obstetric complications (73.8%), and school dropouts (83.8%). This reflects growing community-level recognition of the biological and socio-educational risks associated with early childbearing. Moreover, the overwhelming acknowledgment of early marriage (86.4%) and lack of contraception access (81.2%) as major contributors to teenage pregnancy suggests a critical awareness of key social determinants, particularly important in traditional societies where early marriage is still normalized.

Similarly, attitudes toward preventive measures were encouraging. Most participants supported mandatory sex education (84.3%) and emphasized the importance of community awareness programs (81.7%) and family planning services (78.8%) in mitigating early pregnancies. Additionally, a significant number rejected outdated stigmas associating teenage pregnancy with moral failings (80.5%), demonstrating a gradual cultural shift toward more empathetic and evidence-based perceptions of adolescent reproductive health issues. Notably, 85.0% of respondents agreed on the role of school-based counseling, reflecting strong community openness toward institutional preventive efforts.

However, persistent misconceptions and gaps demand urgent attention. Only 68.3% correctly rejected the false belief that teenage pregnancy improves immunity, and merely 62.1% recognized the cardiovascular risks associated with adolescent pregnancy. These findings expose partial or superficial knowledge, particularly regarding lesser-known but serious medical complications, underscoring the need for comprehensive education efforts that cover not only the visible consequences but also the less understood but equally critical health risks. Furthermore, while most participants accepted the importance of education in delaying marriage, nuanced understanding about the socio-economic drivers and mental health repercussions of teenage pregnancy was moderate, indicating areas for intensified public health messaging.

Knowledge score classification further illuminates the awareness landscape: while nearly three-fourths of participants (74.8%) fell into the "Good" and "Very Good" categories, a concerning 25.2% were categorized under "Fair" or "Poor" awareness levels. This sizable vulnerable cohort, primarily those from lower education brackets and rural areas, represents individuals most at risk of perpetuating the cycle of early pregnancy due to misinformation, lack of access to services, and socio-cultural pressures. Thus, future interventions must prioritize reaching these populations with tailored, accessible, and culturally sensitive educational strategies.

These findings hold significant implications for public health initiatives in Himachal Pradesh and similar contexts. Mere improvements in literacy rates are not sufficient; comprehensive, age-appropriate, and community-driven reproductive health education must be actively promoted. Special emphasis should be placed on equipping adolescents, parents, teachers, and healthcare workers with accurate, stigma-free information on reproductive health, contraception, and the risks associated with teenage pregnancy. Additionally, strengthening access to adolescent-friendly health services, promoting delayed marriage practices through legal and community advocacy, and fostering supportive environments for adolescent girls to continue their education are critical steps toward sustainable prevention.

It is important to recognize some limitations of this study. Being an online survey, there is a possibility of digital access bias, possibly underrepresenting those in remote areas with limited internet connectivity—who may arguably have even lower awareness levels. Furthermore, self-reported knowledge assessments carry inherent risks of social desirability bias, possibly leading some respondents to overstate their awareness. Future research using mixed methods—combining surveys with in-depth interviews or focus group discussions—could yield richer, more nuanced insights into attitudes, beliefs, and barriers surrounding teenage pregnancy prevention.

In conclusion, while community awareness of teenage pregnancy and its health and educational consequences is growing among the population of Himachal Pradesh, substantial knowledge gaps and persisting myths still hinder comprehensive understanding and effective prevention. Focused, culturally sensitive education and outreach programs are urgently needed to deepen public knowledge, shift social norms, empower young women, and foster community environments that support delayed marriage, education retention, and healthier reproductive outcomes. Proactively addressing these challenges today can ensure that the futures of Himachal Pradesh’s young women are no longer defined by early, preventable motherhood but by opportunity, autonomy, and well-being.

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