Trends in Repeat Births and Use of Postpartum Contraception Among Teens — United States, 2004–2015

Deborah L. Dee, PhD; Karen Pazol, PhD; Shanna Cox, MSPH; Ruben A. Smith, PhD; Katherine Bower, PhD; Martha Kapaya, MPH; Amy Fasula, PhD; Ayanna Harrison; Charlan D. Kroelinger, PhD; Denise D'Angelo, MPH; Leslie Harrison, MPH; Emilia H. Koumans, MD; Nikki Mayes; Wanda D. Barfield, MD; Lee Warner, PhD


Morbidity and Mortality Weekly Report. 2017;66(16):422-426. 

In This Article

Abstract and Introduction


Teen* childbearing (one or more live births before age 20 years) can have negative health, social, and economic consequences for mothers and their children.[1] Repeat teen births (two or more live births before age 20 years) can constrain the mother's ability to take advantage of educational and workforce opportunities,[2] and are more likely to be preterm or of low birthweight than first teen births.[3] Despite the historic decline in the U.S. teen birth rate during 1991–2015, from 61.8 to 22.3 births per 1,000 females aged 15–19 years,[4] many teens continue to have repeat births.[3] The American College of Obstetricians and Gynecologists and the American Academy of Pediatrics both recommend that clinicians counsel women (including teens) during prenatal care about birth spacing and postpartum contraceptive use,[5] including the safety and effectiveness of long-acting reversible methods that can be initiated immediately postpartum. To expand upon prior research assessing patterns and trends in repeat childbearing and postpartum contraceptive use among teens with a recent live birth (i.e., 2–6 months after delivery),[3] CDC analyzed data from the National Vital Statistics System natality files (2004 and 2015) and the Pregnancy Risk Assessment Monitoring System (PRAMS; 2004–2013). The number and proportion of teen births that were repeat births decreased from 2004 (82,997; 20.1%) to 2015 (38,324; 16.7%); in 2015, the percentage of teen births that were repeat births varied by state from 10.6% to 21.4%. Among sexually active teens with a recent live birth, postpartum use of the most effective contraceptive methods (intrauterine devices and contraceptive implants) increased from 5.3% in 2004 to 25.3% in 2013; however, in 2013, approximately one in three reported using either a least effective method (15.7%) or no method (17.2%). Strategies that comprehensively address the social and health care needs of teen parents can facilitate access to and use of effective methods of contraception and help prevent repeat teen births.

National Vital Statistics System natality files, compiled annually by CDC's National Center for Health Statistics, include demographic information such as maternal age, race, and Hispanic ethnicity for all births in the 50 states and the District of Columbia. CDC analyzed national and state-specific natality data for 2004 and 2015 for teens aged 15–19 years in which information about the number of previous live births was available. The total number of births with known birth order to teens aged 15–19 years was 413,144 in 2004 and 228,862 in 2015, representing ≥99% of births in this age group for these years. The percentage change from 2004 to 2015 in teen births that were repeat teen births, overall and for each state, was evaluated using a two-sided Z-test, with significance set at p<0.05.

PRAMS is an ongoing population-based surveillance system designed to monitor selected self-reported behaviors and experiences before, during, and after pregnancy among women with a recent live birth.[6] To measure postpartum contraceptive use among teens aged <20 years,§ CDC analyzed PRAMS data from 30 states and New York City (states) that met survey response rate criteria of 60%** in 2013, and 5 states†† that met response rate thresholds continuously during 2004–2013. Contraceptive methods were placed in three tiers of effectiveness based on the percentage of users who experience pregnancy during the first year of typical use: most effective (<1%),§§ moderately effective (6%–10%),¶¶ and least effective (>10%)***.[7] Teens reporting multiple contraceptive methods were categorized by the most effective method used. Trends in postpartum contraceptive use were analyzed in 2-year increments to account for the complex sampling design of PRAMS. CDC calculated weighted prevalence estimates and 95% confidence intervals and used chi-squared analyses to measure differences in postpartum contraceptive use, and tested for linear and quadratic changes in contraceptive use over time.

*For this report, the term "teen" refers to a person aged <20 years.
CDC National Center for Health Statistics, Division of Vital Statistics, Natality public-use data.
§To measure postpartum contraceptive respondents were asked, "Are you or your husband or partner doing anything now to keep from getting pregnant?" and if the respondent answered affirmatively, she was then asked, "What kind of birth control are you or your husband or partner using now to keep from getting pregnant?" Analyses excluded teens who were currently pregnant, not sexually active, or used nonreversible methods of contraception (male or female sterilization).
The thirty states (Alaska, Arkansas, Colorado, Delaware, Georgia, Hawaii, Illinois, Iowa, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Nebraska, New Hampshire, New Jersey, New Mexico, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming) and New York City are hereafter referred to as "states."
**PRAMS response rates required for states to be included in analyses were 70% for 2004–2006, 65% for 2007–2011, and 60% for 2012–2013.
††Arkansas, Michigan, Nebraska, Oregon, and Rhode Island.
§§Contraceptive implants and intrauterine devices.
¶¶Oral contraceptive pills, injectables (e.g., Depo-Provera), birth control patches, and vaginal rings.
***Condoms, diaphragms, cervical caps, contraceptive sponges, rhythm method/natural family planning, the "morning after pill," withdrawal, and "other" responses that could not be categorized into a more effective category.