In short

• Teen mothers accounted for 11.8% of births in 2023
• Over 1.2 million births to mothers under 20 were recorded from 2014–2023.
• Hotspots cluster in KwaZulu-Natal and the Eastern Cape.
• Young mothers face higher health risks and significantly higher late birth registration, linked to stigma, service barriers and low awareness.
• Targeted outreach, youth-friendly services and reproductive health education are recommended, prioritising high-risk districts.

Births to mothers under the age of 20 years remain a significant share of South Africa’s deliveries. A new HSRC spatial analysis of 9.6-million national birth records spanning over a decade (2014–2023) maps provincial and district hotspots, links late registration to service barriers and recommends targeted outreach, youth-friendly services and campaigns to promote timely birth registration.

Photo: Jan Truter, Flickr

In 2023, young mothers aged 15–19 accounted for 11.8% of all births in South Africa. Pregnancies and births pose serious health and social risks to girls and young women and are associated with higher rates of maternal and child mortality.

Mothers aged 10–19 years face higher risks of eclampsia, puerperal endometritis and systemic infections than women aged 20–24. In 2025, the World Health Organization identified pregnancy complications and unsafe abortions as the leading causes of death among girls aged 15–19 worldwide.

Despite national efforts, such as sexual education and contraception policies, high rates of teenage pregnancies persist in South Africa. To help address service delays and prioritise outreach where need is greatest, HSRC researchers conducted a mapping study to identify high-risk (hotspot) districts. HSRC researcher Sbonelo Chamane and Dr Musawenkosi Mabaso, a research director, analysed 9.6-million birth registrations from 2014 to 2023 to examine spatial variation in births to mothers under the age of 20 years in South Africa.

National prevalence

Births to mothers younger than 20 years in South Africa accounted for 13.0% of all births over the sample period (2014–2023), totalling 1,249,074 births—an average of roughly 342 births to mothers under 20 years per day and about 10 400 each month. Rates decreased slightly from 13.7% (2014–2018) to 12.3% (2019–2023).

District prevalence

Figure 1 shows the distribution of births to all women in South Africa over the sample (left) and the prevalence of births to mothers under 20 (right). The districts with the highest total numbers of births were the City of Cape Town (6.6%), eThekwini (6.4%), the City of Johannesburg (6.3%), the City of Tshwane (6.3%) and Ekurhuleni (6.2%). Districts with the highest prevalence of births to mothers under 20 were Alfred Nzo (23.1%) and OR Tambo (20.6%) in the Eastern Cape, and uMkhanyakude (20.4%) and Zululand (20.2%) in KwaZulu-Natal.

Figure 1. Maps showing the distribution of all births (left) and the prevalence of births to mothers under 20 (right) in each district in South Africa, 2014–2023.

Source: Chamane and Mabaso, 2025.

Provincial prevalence

By province (Table 1), the Eastern Cape recorded the highest prevalence of births to mothers under 20 years (16.9%), followed by KwaZulu-Natal (16.4%), Mpumalanga (15.2%) and Northern Cape (15.1%). At the lower end were Limpopo (12.9%), North West (12.8%), Free State (11.8%), Western Cape (10.1%) and Gauteng (8.2%).

Table 1. The prevalence of births to mothers under 20 by province, 2014–2023

Source: Chamane and Mabaso, 2025

Spatial clusters

In geospatial hotspot analysis, districts are classified by how their rates compare with neighbouring areas. “High-high” and “low-low” clusters describe areas with similarly high or low neighbouring teenage pregnancy rates, while “high-low” and “low-high” describe clusters that differ from their surrounding areas. For example, when a district’s rate is higher than that of nearby neighbourhoods (which are low), that district would be considered high-low.

The study found two main high-high clusters: one in northern KwaZulu-Natal and one in southern KwaZulu-Natal, which extended into the Eastern Cape. A low-high outlier was identified in the uMgungundlovu district, indicating lower local rates surrounded by higher-rate neighbours. Low-low clusters were observed in northern North West, Mpumalanga, Gauteng and southern Limpopo, showing consistently low teenage pregnancy rates in these areas.

High-high clusters highlight where teenage pregnancies are concentrated and where interventions are most urgently needed, while low-low areas with consistently low rates offer insight into contexts where protective factors may exist. Low-high outliers, such as uMgungundlovu, suggest possible spillover effects from neighbouring high-risk areas.

Birth registration timing

Late birth registrations, defined as occurring more than 30 days after birth, can delay a child’s legal recognition and limit access to basic services. Births to mothers under 20 were significantly more likely to be registered late. Of all births, 5.3% were registered late, while 34% of births to young mothers (<20 years) were registered late.

The study linked late registration to social, cultural and economic factors, including low awareness of registration protocols, stigma and fear of approaching services such as Home Affairs.

Recommendations

The study recommends targeted awareness campaigns and youth-sensitive service environments to promote timely registration among young mothers. Local governments and organisations should implement educational campaigns in hotspot areas focusing on reproductive health, youth empowerment and age-disparate relationships that contribute to unplanned pregnancies. District health departments should prioritise high-risk areas and deploy outreach and mobile health services. The spatial findings of this study can also inform local planning and resource allocation to ensure interventions reach communities where they are most needed.

Impact

The geospatial clustering of births to mothers under 20 shows that they are concentrated in specific districts rather than being evenly distributed across South Africa. These clusters suggest that underlying social, economic and cultural factors—such as poverty, limited access to reproductive health services and age-disparate relationships—are geographically patterned, creating areas of concentrated risk.

Understanding these spatial patterns helps policymakers and health planners to move beyond a one-size-fits-all approach, directing resources, educational programmes and adolescent health services to districts where they can have the greatest impact. In short, mapping helps to identify where the problem is concentrated, why it persists and how interventions can be most strategically targeted.

Research contacts and acknowledgements

This article is based on the paper A Decade of Teenage Pregnancy in South Africa, 2014–2023: A Spatial Analysis of National Birth Records. It was written by HSRC science writer Jessie-Lee Smith and HSRC’s Public Health, Societies and Belonging Division’s Sbonelo Chamane (master’s research trainee), Dr Lehlogonolo Makola (senior research specialist), Simangaliso Mnyandu (DSI Intern) and Dr Musawenkosi Mabaso (research director). For more information, contact Dr Mabaso at mmabaso@hsrc.ac.za.

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