Introduction: Ghana developed its adolescent reproductive health policy in October 2000 to guide the implementation of adolescent reproductive health and related services. Despite a comprehensive policy implementation strategy, the burden of adolescent pregnancies in rural Ghana remains a public health challenge since little is known about the core predictors. This study therefore explores socio-demographic and economic predictors of the pregnancies in Amenfi West district.

Methods: The study design was a community-based case-control study involving 80 cases and 220 controls. Data was collected using structured questionnaires and analyzed by Stata version 11 to examine associations between predictors of pregnancy and background characteristics of adolescents.

Results: Findings show that being in school, coming from a wealthy household, contraceptive use, parental monitoring, and relationship counseling offered significant protection against adolescent pregnancy (p<0.05). However, factors such as violent parental attitudes towards boy/girlfriend relationships, demanding financial support from adolescents for housekeeping, and peer pressure from ever been pregnant friends predispose adolescents to pregnancy.

Conclusion: Advocacy for increased social/parental support for adolescents, education on modern contraception, and availability of services are key to preventing adolescent pregnancies in rural communities