Social Determinants and Eliminating Disparities in Teen Pregnancy

image of teens smiling

US teen birth rates (births per 1,000 females aged 15 to 19 years) decreased 4% overall from 2018 to 2019.1 Decreases in rates occurred among non-Hispanic Black females, non-Hispanic White females and Hispanic females. Despite these declines, racial/ethnic, geographic, and socioeconomic disparities persist. Achieving health equity and eliminating health disparities is an overarching goal of Healthy People 2030external icon. Evidence-based programs and clinical services to prevent teen pregnancy through individual behavior change are important, but research is also shedding light on the role social determinants of health play in affecting disease risks and overall health, including teen pregnancy.

Disparities by Race and Ethnicity

In 2019, the birth rates for Hispanic teens (25.3 per 1,000) and non-Hispanic Black teens (25.8) were more than two times higher than the rate for non-Hispanic White teens (11.4 ). The birth rate for American Indian/Alaska Native teens (29.2) was highest among all races/ethnicities.

Birth Rates for Females Aged 15 to 19 Years, by Race and Hispanic Origin of Mother: United States, 2018 and 2019

Birth Rates per 1,000 Females Aged 15 to 19 Years, by Race and Hispanic Origin of Mother: United States, 2018 and 2019.  All races and origins, 2018: 17.4; 2019: 16.7 Non-Hispanic White, 2018: 12.1; 2019: 11.4 Non-Hispanic Black, 2018: 26.3; 2019: 25.8 Non-Hispanic American Indian/Alaska Native, 2018: 29.7; 2019: 29.2 Non-Hispanic Asian, 2018: 2.8; 2019: 2.7 Non-Hispanic Native Hawaiian or Other Pacific Islander, 2018: 26.5; 2019: 26.2 Hispanic, 2018: 26.7; 2019: 25.3
Data source: Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep. 2021;70(2):1–50.

Social Determinants of Health

Social health determinants are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks (Healthy People 2030external icon). Certain social determinants like high unemployment, low education, and low income have been associated with higher teen birth rates.2 Interventions that address socioeconomic conditions like these can play a critical role in addressing disparities observed in US teen birth rates.

Health Equity

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. Visit CDC’s Health Equity website to learn more.

Geographic Disparities

  • Disparities between US states persist, with state-specific 2019 teen birth rates ranging from 6.6 in New Hampshire to 30.0 in Arkansas.1
  • Across counties, teen birth rates vary greatly:
    • Analysis of data from 2013 through 2014 shows higher-rate counties are clustered in the South and Southwest, but high-rate counties also occur in states with low overall birth rates.2
    • From 2007 through 2015, the teen birth rate was lowest in large urban counties (18.9) and highest in rural counties (30.9).3
    • From 2007 through 2015, the birth rate among teens in rural counties declined only 37%, compared with the decline in large urban counties (50%) and in medium and small counties (44%) during the same period.3

Drivers of Health Inequities

  • Social determinants of health in communities and families may contribute to high teen birth rates. Examples of these factors include the following:
    • Low education and low-income levels of a teen’s family.4
    • Few opportunities in a teen’s community for positive youth involvement.4
    • Neighborhood racial segregation.4
    • Neighborhood physical disorder (e.g., graffiti, abandoned vehicles, litter, alcohol containers, cigarette butts, glass on the ground).4
    • Neighborhood-level income inequality.4
  • Access to quality reproductive health services, including contraception and sexually transmitted infection services, plays an important role in supporting the health and well-being of adolescents and promoting health equity. Yet some teens face barriers in accessing these services.
    • In an analysis of 2006–2010 data on US teens  aged 15 to 19 years, one-quarter of sexually experienced females and one-third of sexually experienced males reported that they had not received a reproductive health service in the past year and receipt was lower among teens without insurance.5
    • Accessing services can be more challenging for young people with lower income, those in foster care or group homes, or those that are justice-involved.6

Taking Action to Eliminate Disparities and Address Social Determinants of Teen Pregnancy

Eliminating disparities in teen pregnancy and birth rates would do the following:

  • Help achieve health equity.
  • Improve the life opportunities and health outcomes of young people.
  • Reduce the economic costs of teen childbearing.

Efforts that focus on social health determinants in teen pregnancy prevention efforts, particularly at the community level, play a critical role in addressing disparities observed in teen births in the United States.

In September 2020, a CDC collaborated with the National Association of Community Health Centersexternal icon to launch the Quality and Access for Reproductive Health Equity for Teens (QARE for Teens) project. The project goal is to put into action quality improvement initiatives focused on best practices in adolescent sexual and reproductive health services in community health centers and carry out strategies to increase access to those services. In 2019, community health centers delivered care to disproportionately affected and under-resourced individuals and families and served 2.3 million patients aged 15 to 19 years. 7, 8

QARE for Teens is built off the 2010–2015 Teen Access and Quality Initiative that supported three organizations to enhance youth-friendly sexual and reproductive health services in publicly funded health centers and increased the number of young people accessing sexual and reproductive health services. A key focus was connecting young people from groups that have been disproportionately affected by these services that include teens involved in the child welfare and juvenile justice systems.

As part of the Department of Health and Human Services Teen Pregnancy Prevention Initiative, CDC partnered with the HHS Offices of Adolescent Health and Population Affairs from 2010 to 2015 to fund nine state- and community-based organizations and five national organizations to address disparities in teen pregnancy and birth rates. Addressing social determinants of teen pregnancy was a central principle of each initiative. For tools and resources that address social determinants of teen pregnancy, please see the Working with Diverse Communities webpage.

  1. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK. Births: final data for 2019. Natl Vital Stat Rep. 2021;70(2):1-50.
  2. Romero L, Pazol K, Warner L, et al. Reduced disparities in birth rates among teens aged 15–19 years—United States, 2006–2007 and 2013–2014. MMWR Morb Mortal Wkly Rep. 2016;65(16):409–414.
  3. Hamilton BE, Rossen LM, Branum AM. Teen birth rates for urban and rural areas in the United States, 2007–2015. NCHS Data Brief. 2016; 264.. 2016.
  4. Penman-Aguilar A, Carter M, Snead MC, Kourtis AP. Socioeconomic disadvantage as a social determinant of teen childbearing in the US. Public Health Rep. 2013;128(suppl 1):5–22.
  5. Tyler CP, Warner L, Gavin L, Barfield W. Receipt of reproductive health services among sexually experienced persons aged 15–19 years—National Survey of Family Growth, United States, 2006–2010. MMWR Surveill Summ., 2014;63(2):89–98.
  6. Brindis, CD, Morreale MC, & English A. The unique health care needs of adolescents. Future Child. 2003; 13(1):117–135. https://doi.org/10.2307/16026 43.
  7. HRSA Health Center Program. Health Resources and Services Administration. What is a Health Center? |Bureau of Primary Health Care (hrsa.gov)external icon. Updated 2018.  Accessed May 21, 2021.
  8. Health Resources and Services Administration. Table 3A: Patients by Age and by Sex Assigned at Birth.  Data.HRSA.gov.  Accessed June 16, 2021. https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=3A&year=2019. Accessed May 21, 2021.