Teen Birth Rates Drop, But Disparities Persist
Health equity is achieved when everyone has an equal opportunity to reach his or her health potential regardless of social position or other characteristics such as race, ethnicity, gender, religion, sexual identity, or disability. Health inequities are closely linked with social determinants of health.
The Guide to Community Preventive Services
Teen birth rates (live births per 1,000 15–19-year-old U.S. females) decreased 25% overall between 2007 and 2011.1 Decreases occurred for all races and for Hispanics. Despite these declines, geographic, socioeconomic, and racial and ethnic disparities persist. Achieving health equity, eliminating disparities, and improving the health of all groups is an overarching goal of Healthy People 2020.2
Disparities by Race and Ethnicity
From 2007–2011, teen birth rates decreased 20% for non-Hispanic whites, 24% for blacks, 27% for American Indian/Alaska Natives (AI/AN), and 34% for Hispanics.1 However, in 2007, non-Hispanic black and Hispanic teen birth rates were more than two times higher than the rate for non-Hispanic white teens, and remained so in 2011.
Understanding Disparities: Looking Beyond Race
Social Determinants of Health
Social determinants are elements of a society's organization and process that affect the overall distribution of disease and health. Examples include education, housing and the built environment, transportation, employment opportunities, the law, and the justice system. The health care and public health systems are also social determinants of health.
In addition to building the evidence to support programs and clinical services to prevent teen pregnancy through individual behavior change, research is shedding light on the complexity of social determinants of teen pregnancy.
- Southern and some western states have persistently higher teen birth rates than northern and eastern states, regardless of race/ethnicity.3
- Teen birth rates are higher in rural counties than in urban centers and in suburban counties regardless of race/ethnicity. In 2010, the teen birth rate in rural counties was nearly one-third higher compared to the rest of the country (43 versus 33 births per 1,000 females aged 15-19 years).4
- Between 1990 and 2010, the birth rate among teens in rural counties declined 32%, which was slower than the decline in urban centers (49%) and in suburban counties (40%).4
- Socioeconomic conditions in communities and families may contribute to high teen birth rates. Examples of these factors include—
- Low education and low income levels of a teen’s family.5
- Few opportunities in a teen’s community for positive youth involvement.5
- Neighborhood segregation.5
- Neighborhood physical disorder (graffiti, abandoned vehicles, litter, alcohol containers, cigarette butts, glass on the ground).5
- Neighborhood-level income inequality.5
- Teens in child welfare systems are at increased risk of teen pregnancy and birth than other groups. For example, young women living in foster care are more than twice as likely to become pregnant compared to those not in foster care.6
Eliminating Disparities: On the Road to Health Equity
Eliminating disparities in teen pregnancy and birth rates would—
- Help achieve health equity.
- Improve the life opportunities and health outcomes of young people.
- Reduce the economic costs of teen childbearing.
Communities Taking Action to Reduce Disparities and Address Social Determinants of Teen Pregnancy
As part of the President's Teen Pregnancy Prevention Initiative, CDC partners with the Office of the Assistant Secretary for Health (ASH), Office of Adolescent Health (OAH), to reduce teenage pregnancy and address disparities in teen pregnancy and birth rates.
Nine state- and community-based organizations funded for 2010–2015 through the ASH/CDC Communitywide Initiative are working to reduce disparities and address social determinants of teen pregnancy. Examples include:
- Analyzing community-level data to identify specific social determinants associated with teen pregnancy in Mobile County.
- Training program staff, youth leadership team, and community partners on the social determinants of health and teen pregnancy.
- Engaging faith-based leaders in teen pregnancy prevention and partnering with Richmond County Juvenile Court and Kids Restart, Inc., to implement evidence-based programs with youth in detention and in the child welfare system.
- Using the Health Equity Index—a community-based assessment tool for identifying social, political, economic, and environmental conditions associated with specific health outcomes—to highlight the associations between teen pregnancy and select social determinants (e.g., low unemployment rates, high rates of poverty).
- Using the data to inform the selection of program and clinical partners located in communities most in need of teen pregnancy prevention efforts.
- Partnering with Capital Workforce Partners to improve youth employment opportunities and enhance knowledge and skill sets in various areas, including reproductive health, among youth aged 14–17 years.
- Hosting “Community Conversations for Action” sessions with community members and leaders in Holyoke and Springfield to determine their roles in reducing teen pregnancy among Latinos, faith communities, court-involved youth, foster youth, and homeless youth.
- Partnering with TLC: Building Healthy Relationship Program to implement ¡Cuidate! with young Latino males involved with the Massachusetts Department of Youth Services/Department of Children and Families.
- Addressing teen pregnancy specifically among urban, lower income, underrepresented racial and ethnic groups in the South Bronx.
- Raising public awareness in Gaston County of the link between teen pregnancy and social determinants of health through documentaries and presentations to community groups; reaching youth of color and males with evidence-based programs; and partnering with faith institutions on teen pregnancy prevention.
- Improving the provision of high quality services for underserved populations by training youth-serving organizations to work with underserved populations; holding focus groups with underserved populations to identify factors affecting teen pregnancy; and partnering with organizations to implement evidence-based programs with detained/incarcerated youth, males, youth in foster care, West African immigrant youth, and pregnant and parenting teens.
- Working with Bexar County Juvenile Probation youth; foster care youth in Baptist Children and Family Services and St. PJ’s Children’s Home; out of school, teen parents in the Adult Detention Center; pregnant and parenting teens through Nurse Family Partnership and Children’s Shelter iParent; and pregnant and parenting teen coordinators in schools.
- Partnering with Spartanburg County Department of Social Services to improve counseling of foster youth on reproductive health, referring youth for clinical services as appropriate, and educating foster parents on teen pregnancy prevention.
- Examining social determinants of teen pregnancy specific to the Spartanburg community such as by engaging Spartanburg Youth Action Board members in a Reproductive Justice Timeline activity to examine how being a minority affects access to reproductive health services and the choices they make.
- Hamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2009. National vital statistics reports. vol 59 no 3. Hyattsville, MD: National Center for Health Statistics. 2010. Table 2.
- Ventura SJ, Abma JC, Mosher WD, Henshaw SK. Estimated pregnancy rates by outcome for the United States, 1990-2004. National vital statistics reports. vol 56 no 15. Hyattsville, MD: National Center for Health Statistics. 2008.
- Singh S, Darroch JE. Adolescent pregnancy and childbearing: levels and trends in developed countries. Family Planning Perspectives. 2000;32(1):14–23.
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