Examining the Social Ecological Context of Teenage Birth Among Native Hawaiian Youth

Purpose: The current study, part of a larger mixed-method examination of Native Hawaiian (NH) teenage pregnancy and parenting, significantly expands existing knowledge as no known studies exist examining factors contributing to the staggering rates of teenage birth in NH communities. The study was guided by the following research question: What is the social ecological context of birth timing among Native Hawaiian women?

Inequities persist in teenage pregnancy despite gains in rate reduction. In Hawai‘i, teenage pregnancy disproportionately affects NH youth, who have a rate of teen birth three times higher than Hispanic and African American youth and five times higher than all U.S. youth. This is a statistic often lost in national rates that combine Asian Americans with Pacific Islanders (including Native Hawaiians), though these populations are diverse in terms of health outcomes in general and teenage pregnancy in particular. As such, NH youth rarely get the attention and resources needed to address pregnancy prevention in culturally-attuned ways.

Teenage pregnancy has serious consequences, including increased risk of infant death, low birth weight, child welfare involvement, poor academic performance, and the child becoming a teen parent themselves, thereby effectively repeating the cycle of risk. Social workers are well-positioned across sectors to affect change both in teenage pregnancy prevention and teenage parenting support that will mitigate negative outcomes.

Method: Drawing on the Hawai‘i Pregnancy Risk and Monitoring Survey (PRAMS), the study team used descriptive statistics and logistic regression to explore predictors of birth timing (teen versus ≥20 years old) among NH women (N= 1493). PRAMS is administered to 200 new mothers/month, exploring a variety of questions about mothers’ experiences and activities.

Results: NH women who gave birth as teens versus at ≥20 years old had significantly* lower household incomes (65% vs. 27% under $10,000 per year) and higher use of WIC during pregnancy (78% vs 59%), intimate partner violence (IPV) prior to pregnancy (14% vs. 6%) and during pregnancy (9% vs. 4%), emotional stress (41% vs. 31%), traumatic stress (32% vs. 20%), and marijuana use (15% vs. 7%). Teenage mothers reported significantly* lower rates of binge drinking than mothers ≥20 years old (32% vs. 54%). Fifteen percent of teenage mothers reported desiring to become pregnant and 10% reported trying to get pregnant. Only 49% of those who did not desire pregnancy were actively avoiding it using contraception. Fifteen percent reported having had a previous birth. Logistic regression noted significant* differences in odds ratios between teenagers versus mothers ≥20 years old in wanting to become pregnancy (OR .25), trying to get pregnant (OR .21), previous birth (OR .08), emotional stress (OR 1.78), and binge drinking (OR. 41).

Implications: The high rates of IPV both prior and during pregnancy among NH teenage mothers are concerning. Exploring the circumstances of pregnancy in future research as well as directly intervening within these violent relationships appears particularly important to ensure young women are able to make sexual health choices within a safe environment. Findings also suggest NH teenage mothers need support to mitigate emotional stress.

*p <.05