Background <p>Teenage pregnancy continues to be a significant public health concern that carries several health risks. This study assesses the trends of teenage pregnancy in Tanzania and identifies key individual and community factors influencing its occurrence.</p> Methods <p>This study used a pooled weighted sample of 10,404 teenagers (aged 15–19) from four waves of the Tanzania Demographic and Health Surveys. Given the complex survey design, a multilevel logistics regression model was used to examine the trends and predictors of teenage pregnancy from 2004 to 2022. Both fixed and random effects were estimated.</p> Results <p>The overall pooled weighted prevalence of teenage pregnancy was 24.1% (95%CI: 22.9–25.3) across all survey waves. The trends showed that between the years 2004/05 and 2010, the prevalence decreased from 26.0 to 22.8%, increased again to 26.7% in 2015/16, and once more, declined to 21.1% in 2022. The individual factors associated with a high rate of teenage pregnancy were increased age (AOR = 2.36, 95%CI: 2.22–2.50) and working (AOR = 1.34, 95%CI: 1.14–1.56). However, primary education (AOR = 0.70, 95%CI: 0.54–0.91), secondary or higher education (AOR = 0.13, 95%CI: 0.09–0.18), literate teenagers (AOR = 0.76, 95%CI: 0.61–0.94) and socioeconomic status of richest quantile (AOR = 0.38, 95%CI: 0.27–0.54) were less likely to experience teenage pregnancy. Regarding community-level factors, high literacy communities (AOR = 0.79, 95%CI: 0.67–0.95) were less likely to experience teenage pregnancy, while rural settings (AOR = 1.18, 95%CI: 1.02–1.31) exhibited higher odds.</p> Conclusion <p>The interplay between education, employment, and access to reproductive health services, ongoing disparities, particularly in rural settings and socio-economic contexts, is associated with a persistent prevalence of teenage pregnancy. Thus, continued efforts are paramount to addressing teenage pregnancy with a multi-dimensional approach at the individual, community, and policy levels.</p>