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

Abstract

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.

FIGURE 1

Percent change in repeat teen births —United States, 2004–2015 * Repeat teen births are two or more live births to a mother aged <20 years ^† Data for 2004 and 2015 downloaded from CDC WONDER (https://wonder.cdc.gov).

FIGURE 2

Trends and distribution of postpartum contraception method use among teens — Pregnancy Risk Assessment Monitoring System, five states, 2004–2013 * Methods categorized by effectiveness, as determined by the percentage of females who experience pregnancy during the first year of typical use as the following: most effective (contraceptive implant and intrauterine device) (<1%); moderately effective (oral contraceptive pill, an injectable [e.g., Depo-Provera], birth control patch, and vaginal ring) (6–10%); and least effective (condom, diaphragm, cervical cap, contraceptive sponge, rhythm method/natural family planning, the “morning after pill,” withdrawal, and “other” responses that could not be categorized to a more effective category) (>10%); also includes measure of teen mothers who report no postpartum contraceptive use. ^† For this report, the term “teens” refers to persons aged <20 years.