Purpose The rural areas of Colombia represent distinct regions with some of the more entrenched male power imbalances (machismo) in Latin America and Caribbean. Pregnancies among adolescents are associated with significant social, health, educational and economic outcomes. The aim of this study was to identify the determinants of adolescent pregnancy in Colombia. Methods: The 2015 Demographic Health Survey data were used to compare rates of adolescent pregnancy with female empowerment scores and other sociodemographic characteristics across regions. Results: The analysis included 16,251 females with 27% of them having a pregnancy during adolescence. We found low education, low wealth index, low female empowerment, and older sexual partners to be significant determinants for adolescent pregnancy. Conclusions: The findings highlight the need for a sexual health paradigm that addresses young female adolescent empowerment particularly in rural Colombia.