Educational Disruption, School Dropout, and Sexual and Reproductive Health (SRH) Outcomes Among Adolescent Girls and Young Women in South Africa.

Adolescent girls and young women (AGYW) in South Africa continue to experience high rates of HIV, early pregnancy, and gender-based violence (GBV). While schooling is widely recognised as protective, most studies conceptualise educational participation as a binary exposure, overlooking variation in absenteeism and school dropout. This study examined whether school dropout and varying levels of absenteeism were associated with HIV status, early pregnancy, contraceptive use, intimate partner violence (IPV), and non-partner sexual violence among AGYW in South Africa. Data were drawn from the HERStory 3 Impact Evaluation (2024), a multi-province quasi-experimental study conducted across 24 sub-districts in eight provinces. Household surveys and biomarker-confirmed HIV testing were completed among AGYW aged 15-24 years. Analyses included AGYW currently enrolled in school (n = 2,275) and AGYW not enrolled in school (n = 1,842). Mixed-effects regression models accounting for household and geographic clustering were used to estimate associations between educational disruption and sexual and reproductive health (SRH)/GBV outcomes. AGYW not enrolled in school had higher HIV prevalence (14.1% vs. 7.7%) and pregnancy history (48.2% vs. 20.6%) than those enrolled. Among out-of-school AGYW, dropout before Grade 12 completion was associated with higher HIV positivity, early pregnancy, IPV, and sexual violence. Among AGYW still enrolled, frequent absenteeism was associated with early pregnancy, IPV, and sexual violence. The findings are consistent with a continuum of educational disengagement in which absenteeism may represent an earlier manifestation of vulnerability that, for some AGYW, precedes school dropout. Monitoring school attendance may help identify AGYW at elevated risk before formal school exit.