What Do U.S. Geographic “Hot Spots” for Teen Pregnancy Tell Us?

Summary and Comment |
June 2, 2017

What Do U.S. Geographic “Hot Spots” for Teen Pregnancy Tell Us?

  1. Anna Wald, MD, MPH

Despite a national decline in teen birth rates, clusters with high rates persisted even after adjustment for poverty and education.

  1. Anna Wald, MD, MPH

Only 50% of teenaged mothers live above the poverty line, and only 50% earn high school diplomas, highlighting two key sequelae of early pregnancy. Birth rates are highest in the southern U.S. To better understand the causes of teen pregnancy, investigators surveyed rates of live birth among teens (age range, 15–19 years) at a more granular level: by U.S. county.

Teen birth rates varied widely, with “hot spots” having rates up to 87% higher than neighboring counties. To understand the extent to which poverty and lack of education confounds these observations, the authors created maps adjusted for these two variables. Although each adjustment shifted the distribution of hot spots, neither fully explained the substantial variations in rates. Notably, 8 of the 10 highest clusters were located in areas that included Native American reservations.

Comment

Providing access to contraception (preferably long-acting types) represents the only evidence-based approach to reducing teenage pregnancies, especially given that attempts to change adolescent sexual behavior have been largely unsuccessful. The persistence, even after adjustment, of geographic clusters having high teenage birth rates reinforces that the causes go beyond poverty and education — and underscores the importance of facilitating access to highly effective contraceptives.

Editor Disclosures at Time of Publication

  • Disclosures for Anna Wald, MD, MPH at time of publication Consultant / Advisory board AiCuris Royalties UpToDate Grant / Research support NIH/National Cancer Institute; NIH/National Institute of Allergy and Infectious Diseases; Genocea Biosciences; Vical Editorial boards Sexually Transmitted Diseases; Sexually Transmitted Infections Leadership positions in professional societies International Society for Sexually Transmitted Diseases Research (Board Member)

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