Clusters of teen births trigger public health questions


(Reuters Health) - Though the number of American teenagers having babies has dropped over the past half century, a new study finds regional clusters with strikingly high teen birth rates.

The clusters tended to be in southern states, with three of the top 10 in Texas, but they also popped up in Denver, Colorado; Fresno, California; and Yakima, Washington.

The number one urban center with a cluster was San Antonio, Texas, with an average birth rate for 15 to 19-year-olds of 67 per 1,000, which was 87 percent higher than the average national teen birth rate.

The maps of teen-birth clusters shifted when investigators adjusted for poverty and lack of education, two factors researchers long ago identified as likely contributors to teen pregnancy.

After considering the effect of poverty, for example, San Antonio dropped from the top spot to the fifth, and after taking education level into account, San Antonio dropped out of the top 10, the study found.

After adjusting for lack of a high school diploma, Denver took the top spot with a cluster of teen births that showed the risk of a teenager having a baby more than twice as high as the average in the rest of the nation.

The map shifts reveal that factors other than poverty and lacking a high school degree contribute to regional clusters of high teen birth rates, said one of the study authors, Dr. Julie DeCesare, an obstetrician and professor at the University of Florida College of Medicine in Pensacola.

"We've focused on poverty and education, and maybe that's worked thus far because overall we're seeing a reduction in unintended pregnancy," she said in a phone interview.

"But to get those rates lower, we're going to have to look and see what's contributing in our own communities," she said. "What's contributing in St. Louis may be different than what's contributing in Kansas City."

Using national data, the report in the journal Obstetrics and Gynecology counted the number of 15- to 19-year-olds who gave birth by county between 2006 and 2012 and identified clusters of high rates in areas with more than 100,000 teenage females.

Children born to teen mothers are more likely to struggle academically, to be subjected to abuse, to be involved in crime and to experience developmental delays and depression, the authors write.

Only 51 percent of teenage mothers earned high school diplomas by age 22, compared with 89 percent of their peers without children, and 48 percent of teen mothers lived below the poverty line.

The research offers no answers to questions about which factors other than poverty and lack of education contribute to teenagers bearing children, DeCesare said.

"Our study doesn't give any answers," she said. "Our study only identifies the problem."

Kathryn Kost, director of domestic research for the Guttmacher Institute in New York, suggested that access to sex education, contraception and abortion might be factors contributing to the teen-birth clusters.

"We have some clues," said Kost, who was not involved in the new study. "Access to abortion might be playing into the variation in birth rates."

"We also know that the variation in what's available in sex education across the country is enormous," she said.

One limitation of the study, Kost said, is that it examined only where teens are giving birth, not necessarily where they're getting pregnant. She also pointed out that public health officials and policymakers might look at the maps with an eye toward preventing teen pregnancy, but she believes the maps also point to the need for support and resources for teen mothers.

"Whereas this study shows that access to services is not universally available in the United States, and there's still a lot more we can do to help young women who don't want to get pregnant, this study also shows there's more we can do by paying attention to the young women who are giving birth to ensure they receive the support they need," she said.

"Oftentimes we forget about those who have had the child, and they are deserving of attention and resources as well," she said.

DeCesare said she and her colleagues now are examining the clusters to try to tease out what's going on in those communities so that strategies can be developed to lower unintended teen birth rates.

"The message for policymakers is that if your city or your population center is on this list," she said, "support local research into this problem so you can design some interventions that work to help reduce this teen birth rate."

SOURCE: Obstetrics and Gynecology, June 2017.