Teenage pregnancy (pregnancy among girls aged 13-19 years) is prevalent in Uganda but data about the associated factors are limited. To determine the prevalence and factors associated with teenage pregnancy in Buliisa district, western Uganda. We hypothesized that fertility awareness is associated with reduced likelihood of teenage pregnancy. In this cross-sectional study, we included girls aged 15-19 years and collected data using a structured questionnaire. The modified Poisson regression analysis was used to determine the association between fertility awareness and teenage pregnancy, adjusted for confounders, reported using adjusted prevalence risk ratio (aPR) and 95% confidence interval (CI). Of 246 teenagers, the prevalence of teenage pregnancy was 41.5% while fertility awareness was 56.7%. The age category 18-19 years (aPR, 3.44; 95% CI, 2.16-5.47), fertility awareness (aPR, 1.80; 95%CI, 1.30-2.51) and Muslim faith (aPR, 1.37; 95%CI, 1.04-1.80) were associated with increased likelihood of teenage pregnancy. Living with a father (aPR, 0.61; 95%CI, 0.48-0.76), mother (aPR, 0.65; 95%CI, 0.524-0.81), or both parents (aPR, 0.57; 95% CI, 0.43-0.76) was associated with a reduced likelihood of teenage pregnancy. The prevalence of teenage pregnancy in Bulisa district is high. There is a need to target teenagers with correct fertility information, including the engagement of parents and religious leaders.