EXECUTIVE SUMMARY

Although the rate of teen births has decreased in recent years, results of a new analysis shows that that many teens continue to have repeat births. Most adolescent mothers take steps to prevent another pregnancy, but data indicate one in three is using a least-effective contraceptive method or no contraception at all.

  • Repeat teen births, defined as two or more live births before age 20, can affect mothers and babies in multiple ways. Repeat births can impede an adolescent mother’s ability to take advantage of educational and workforce opportunities; babies that are born of repeat teen pregnancies are more likely to be preterm or of low birthweight than first teen births.

Although the rate of teen births has decreased in recent years, results of a new analysis shows that that many teens continue to have repeat births. Most adolescent mothers are taking steps to prevent another pregnancy, but data indicate one in three uses either a least-effective contraceptive method or no contraception at all.1

Repeat teen births, defined as two or more live births before age 20, can affect mothers and babies in several ways. Repeat births can impede an adolescent mother’s ability to take advantage of educational and workforce opportunities.2 Babies that are born of repeat teen pregnancies are more likely to be preterm or of low birthweight than first teen births.3

In 2015, the national teen birth rate was 22.3 births per 1,000 females 15-19 years of age; however, many teens continue to have repeat births.4 The Contraceptive CHOICE project in St. Louis, which was designed promote the use of LARC methods and provide contraception in an effort to reduce unintended pregnancies, has produced a significant decline in repeat abortions in the St. Louis region.5

Because repeat teen births are more likely than first teen births to be preterm and low birth weight, and giving birth more than once as a teenager can limit a mother’s ability to attend school and obtain work experience significantly, it is important to assess patterns in repeat teen births and better understand contraceptive use within this population, according to Deborah Dee, PhD, lead author of the current research and an epidemiologist at the CDC’s Division Of Reproductive Health.

“Our analysis found that, in 2015, one in six births to teens ages 15 to 19 was a repeat birth, a decline from one in five in 2004,” Dee says. “We also found that about a quarter of teen mothers used one of the most effective methods of contraception (i.e., less than 1% failure rate) in 2013 — five times higher than in 2004.”

However, overall contraceptive use among teen mothers did not change during this same period, and one-third of teen mothers used a least-effective contraceptive method (defined as a method with more than a 10% failure rate) or no contraception at all in 2013, Dee observes. There were geographic and racial/ethnic differences in both the trend in repeat teen births and in the use of postpartum contraception, she states. During the analysis period, researchers found 35 states experienced a significant decline in percentage of teen births that were repeat births. Among those 35 states, a dozen experienced declines of more than 20%.1

How to Stem Repeat Births?

Efforts are underway to help stem repeat teen births. Some states have implemented policies that provide enhanced reimbursement of immediate postpartum long-acting reversible contraception insertion for Medicaid-enrolled mothers, thereby removing healthcare system barriers.6 Other states now provide support services to teen parents, such as home visiting programs, which have been found to reduce repeat teen births.7

Fighting teen repeat births can present challenges. According to the Texas Campaign to Prevent Teen Pregnancy, Texas leads the nation in repeat teen births. The campaign estimates one in four births among teens 15-19 years of age in Texas is a repeat birth.

In Texas, teen parents hold medical authority over their children, but do not have the ability to make decisions about their own healthcare. This means that teen mothers cannot get birth control without their parents’ approval, even though they are already parents themselves, according to the campaign.

Robert Hatcher, MD, MPH, senior author of the newly-updated handbook, Managing Contraception, suggests that Texas’ position as number one in repeat teen births is explained by its policies.

“This is a remarkably outrageous duet being orchestrated by a state that used to be a leader in family planning,” Hatcher says. “The duet is denying teenagers the ability to choose their contraceptives, while permitting them to make health decisions about the children that may follow as a result of unprotected sex.”

During the 2017 session of the Texas Legislature, Texas House Rep. Sarah Davis of Houston filed the Minor-Parental Consent to Contraception Bill (HB 1373), which sought to change policy to give teen parents the freedom to choose an effective contraceptive method, such as long-acting reversible contraception, without requiring parental consent. The House State Affairs committee considered the bill in March and approved it in May. However, lawmakers did not consider the bill on the floor and it died because of end-of-session deadlines, reports Melanie Chasteen, director of community engagement for the Texas Campaign to Prevent Teen Pregnancy.

REFERENCES

  1. Dee DL, Pazol K, Cox S, et al. Trends in repeat births and use of postpartum contraception among teens — United States, 2004-2015. MMWR Morb Mortal Wkly Rep 2017;66:422-426.
  2. Klerman L. Another Chance: Preventing Additional Births To Teen Mothers. Washington, DC: National Campaign to Prevent Teen and Unplanned Pregnancy; 2004. Available at: http://bit.ly/2sxa6Pq. Accessed June 20, 2017.
  3. Centers for Disease Control and Prevention. Vital signs: Repeat births among teens - United States, 2007-2010. MMWR Morb Mortal Wkly Rep 2013;62:249-255.
  4. Martin JA, Hamilton BE, Osterman MJ, et al. Births: Final data for 2015. Natl Vital Stat Rep 2017;66:1.
  5. Peipert JF, Madden T, Allsworth JE, et al. Preventing unintended pregnancies by providing no-cost contraception. Obstet Gynecol 2012;120:1291-1297.
  6. Department of Health and Human Services. Centers for Medicare & Medicaid Services. State Medicaid payment approaches to improve access to long-acting reversible contraception. Available at: http://bit.ly/1WlaybL. Accessed June 20, 2017.
  7. Department of Health and Human Services. Health Resources and Services Administration. Maternal and Child Health. Maternal, Infant, and Early Childhood Home Visiting Program. Available at: http://bit.ly/2kSDw3z. Accessed June 20, 2017.