Social Determinants and Eliminating Disparities in Teen Pregnancy
US teen birth rates (births per 1,000 females aged 15 to 19 years) decreased 7% overall from 2016 to 2017.1 Decreases occurred for teens of most racial groups races and for Hispanic teens. Despite these declines, racial/ethnic, geographic, and socioeconomic disparities persist. Achieving health equity, eliminating disparities, and improving the health of all groups is an overarching goal of Healthy People 2020External. 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 the overall distribution of disease and health, including teen pregnancy.
In 2017, the birth rates for Hispanic teens (28.9 per 1,000) and non-Hispanic black teens (27.5) were more than two times higher than the rate for non-Hispanic white teens (13.2). The birth rate for American Indian/Alaska Native teens (32.9) was highest among all races/ethnicities.1
Social health determinants include a person’s age and the environment in which people are born, live, learn, work, play, and worship. The health determinants affect a wide range of health issues and quality-of-life outcomes and risks. (Healthy People 2020External). Certain social determinants, such as 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 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. Learn more at the Community Guide websiteExternal.
- Disparities between U.S. states persist, with state-specific 2017 teen birth rates ranging from 8.1 in Massachusetts to 32.8 in Arkansas.1
- Across counties, teen birth rates vary greatly:
- 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 2007-2015, 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
- Socioeconomic conditions 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
- 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 than those not in foster care.5
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 racial/ethnic and geographical disparities observed in teen births in the United States.
CDC is supporting three organizations from 2015 to 2020 to enhance youth-friendly sexual and reproductive health services in publicly funded health centers and increase the number of young people accessing sexual and reproductive health services. A key focus is working to refer and link vulnerable young people to these services—including those in foster care, juvenile justice and probation, or housing developments. The three organizations funded to conduct this work are Sexual Health Initiative for Teens North Carolina (Durham, North Carolina), Mississippi First, Inc. (Coahoma, Quitman, and Tunica counties, Mississippi), and the Georgia Association for Primary Health Care, Inc. (Chatham County, Georgia).
The US Department of Health and Human Services’ Office of Adolescent Health (OAH) and CDC recently partnered to fund the evaluation of innovative interventions designed for young men aged 15 to 24 years to reduce their risk of fathering a teen pregnancy. Interventions focused on young men at high risk of fathering a teen pregnancy, such as young men at risk of health disparities due to low socioeconomic status, race/ethnicity, or exposure to other social determinants negatively affecting health. Columbia University, New York University, and Promundo were the organizations funded to conduct this work.
As part of the Department of Health and Human Services Teen Pregnancy Prevention Initiative, CDC partnered with OAH and the HHS Office of Population Affairs from 2010 to 2015 to fund nine state- and community-based organizations and five national organizations to implement communitywide initiatives to reduce teenage pregnancy and 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 related to addressing social determinants of teen pregnancy, please see the Working with Diverse Communities webpage.
- Reduced Disparities in Birth Rates Among Teens Aged 15–19 Years — United States, 2006–2007 and 2013–2014, MMWR 2016
- Public Health Reports: “Socioeconomic Disadvantage as a Social Determinant of Teen Childbearing in the United States”.Cdc-pdf[PDF – 483KB]External
- CDC: Promoting Health Equity: A Resource to Help Communities Address Social Determinants of HealthCdc-pdf[PDF – 392KB]
- CDC: Healthy Communities Program Attaining Health Equity Website.
- CDC: Social Determinants of Health Website
- Healthy People 2020: Social Determinants of HealthExternal Website
- World Health Organization: Social Determinants of HealthExternal Website
- Reproductive Health Equity for Youth: Information, Tools and Resources to Address Social Determinants and Disparities in Teen PregnancyExternal Website(from national partner John Snow, Inc./JSI Research & Training Institute)
- Public Health Reports: “Applying Social Determinants of Health to Public Health PracticeExternal“
- CDC NCHHSTP White Paper: Establishing a Holistic Framework to Reduce Inequities in HIV, Viral Hepatitis, STDs, and Tuberculosis in the United StatesCdc-pdf[PDF – 304KB]
- Robert Wood Johnson Foundation: A New Way to Talk about the Social Determinants of HealthExternal Website
- Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: Final Data for 2017. National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System Cdc-pdf[988KB]. 2018;67(8):1-50.
- Reduced disparities in birth rates among teens aged 15–19 years—United States, 2006–2007 and 2013–2014. April 29, 2016;65(16):409–414.
- Hamilton BE, Rossen LM, Branum AM. Teen birth rates for urban and rural areas in the United States, 2007–2015. NCHS data brief, no 264. Hyattsville, MD: National Center for Health Statistics. 2016.
- 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.
- Boonstra HD. Teen pregnancy among women in foster care: a primer. Guttmacher Policy Review.2011;14(2).