Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Health is one of the key domains of well-being that impacts the future of older adolescents leaving the foster care system. Much of the focus on health care delivery in the child welfare system has been on ensuring access to health care through Medicaid enrollment. Because all wards of the state are eligible for Medicaid, health insurance coverage does not become an issue until youth leave the foster care system. As young adults, the need for access to reproductive health care is paramount in the lives of many of these young people.

Using data from the Midwest Study of the Adult Functioning of Former Foster Youth (Midwest Study), this paper examines the trends in pregnancy and reproductive health services among older adolescents. Using data from two waves of data collection, the rates of pregnancy and health care utilization are examined at both age 17 and age 19. The data at age 19 are used to compare the outcomes of foster youth who leave the foster care system and those who remain in care, a choice largely dependent on state policy. Findings for the study sample are also compared to trends observed among comparably aged youth in the National Longitudinal Study of Adolescent Health.

The study found that nearly one third of the female foster youth in the sample reported that they had ever been pregnant at age 17 compared to 13.5 percent of the females in the Add Health sample. Moreover, by the time of their second interview (approximately 19 years of age), nearly half of the females in our sample reported that they had ever been pregnant. This is significantly higher than the 20 percent of 19-year-old females in the national Add Health sample who reported at least one pregnancy. By the end of their teenage years, female youth in foster care are 2.5 times more likely to have been pregnant than their Add Health counterparts.

Several indicators reveal that youth who have exited foster care have a greater need for reproductive health care. Slightly more of the females who were no longer in care reported a pregnancy compared with those still in care (32% still in c care; 45% no longer in care). Of those who became pregnant, a higher percentage became pregnant more than once, with nearly one-quarter of the females no longer in care reporting two or more pregnancies compared with approximately nine percent of foster youth still in care. One unexpected finding was that females who were no longer in care were more likely to have received prenatal or post-partum services if they became pregnant than females who were still in care. Given the prevalence of teen pregnancy and childbirth in this population, insuring the use of prenatal care is an essential step in supporting healthy trajectories for these adolescents in foster care as well as their children. The results have implications for services that are provided to wards upon their discharge from the child welfare system.