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

Disclosures

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

In This Article

Discussion

From 2004 to 2015, the number and proportion of teen births in the United States that were repeat births decreased 53.8% and 16.9%, respectively. Further, the percentage of teens with a recent live birth who used a most effective contraceptive method postpartum increased substantially during 2004-2013, from 5.3% to 25.3%. This increase in teens' use of the most effective contraceptive methods mirrors the pattern observed among all reproductive-aged women who participated in the National Survey of Family Growth during this period.[8] Despite these improvements, in 2015, one in six teen births was a repeat birth, and in 2013, one in three teens with a recent live birth used either a least effective method or no method of contraception.

These results demonstrate a shift in the distribution of the types of reversible contraception used by teens with a recent live birth; use of the most effective contraceptive methods increased, with a concomitant decline in use of moderately effective methods, and no significant change in use of least effective methods or no method. Recently developed clinical performance measures for contraceptive care have established the use of most or moderately effective methods as an indicator of quality family planning service provision and can help identify populations where a need exists for improving access to contraception in the postpartum period.††† Strategies for increasing access to postpartum contraception among parenting teens include provision of youth-friendly services that address adolescent confidentiality concerns, adequate client-centered counseling, and increased provider and consumer awareness of the full range of contraceptive methods.[9]

Previous analyses have found wide variation in postpartum contraceptive use among teens across states.[3,10] Although states vary in sociodemographic factors that might influence repeat births among teens, variation also exists in the implementation of measures designed to increase access to and use of immediate postpartum long-acting reversible contraception among women, including teens.[11] For example, some states have implemented policies that provide enhanced reimbursement of immediate postpartum long-acting reversible contraception insertion for Medicaid-enrolled mothers, thereby removing health care system barriers.§§§,¶¶¶,**** In addition, some states provide support services to teen parents, such as home visiting programs,††††,§§§§ which have been found to reduce repeat teen births.

The findings in this report are subject to at least five limitations. First, although contraceptive effectiveness is dependent on both consistent and correct use, particularly for the least effective methods, neither of these attributes was measured through PRAMS questions. Second, data on postpartum contraceptive use were only available in the PRAMS states with response rates that met the reporting threshold; therefore, findings might not be generalizable to all states. Third, because of small sample sizes, state-level prevalence estimates for certain categories of contraceptive effectiveness were unstable, with wide and overlapping confidence intervals. Fourth, PRAMS data are self-reported and thus potentially subject to social desirability bias. Finally, although the rate of repeat teen births (per 1,000 female teens) might better reflect changes in the population of females at risk for having a repeat teen birth, this report highlights strategies to reduce the proportion of teen births that are repeat births.

This report found continued decreases in repeat teen births and increases in use of the most effective contraceptive methods among teens with a recent live birth. At the same time, use of moderately effective methods declined and use of least effective methods or no method remained stable. Further reducing repeat births among teens requires ensuring access to the full range of Food and Drug Administration–approved methods of contraception during the postpartum period[11] and increased use of moderately effective and most effective methods.

††† https://www.hhs.gov/opa/performance-measures/index.html.
§§§Additional information about state Medicaid approaches to improve access to LARC is available at https://www.medicaid.gov/federal-policy-guidance/downloads/cib040816.pdf.
¶¶¶Additional information about Medicaid reimbursement of postpartum LARC in the hospital setting is available at http://www.acog.org/About-ACOG/ACOG-Departments/Long-Acting-Reversible-Contraception/Immediate-Postpartum-LARC-Reimbursement.
****Additional information about the Association of State and Territorial Health Officials' state learning communities and state initiatives to improve access to contraception is available at http://www.astho.org/Programs/Maternal-and-Child-Health/Long-Acting-Reversible-Contraception-LARC/.
††††Additional information about the federal home visiting program is available at https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting-overview.
§§§§Additional information about programs for expectant and parenting teens is available at https://www.hhs.gov/ash/oah/grant-programs/pregnancy-assistance-fund/index.html.

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