Predictors of Early Pregnancy Among Female Foster Youth: An Analysis of Medicaid Claims Data

Background & Purpose:  Adolescent pregnancy is a serious social and public health issue among foster care youth, and has long term implications for the physical health of both these teen mothers and their babies.  Although the birth rates among the general population of adolescent females has been decreasing for most of the past 10 years (CDC, Division Reproductive Health, 2015), pregnancy among foster care youth is significantly higher than among general population adolescents (Love at al., 2005). Even more troubling is the fact that many foster youth who become pregnant experience a repeat pregnancy before age 19 (Dworsky & Courtney, 2010).

 Methods: This longitudinal cohort study used matched child welfare and Medicaid claims administrative data from one state provided by the State’s Departments of Human Services and Community Health collected between 2009 and 2012. Data was analyzed with SPSS using descriptive and multivariate statistics. 4721female foster care youth (31% white, 47% African American, and 30% other) between the ages of 14 and 20 years met the criteria for inclusion in this study.

 Results: Overall, 38% of the sample had at least 1 pregnancy and/or delivery charge during the study period.  Of those with a pregnancy or delivery charge, the range of delivery charges was1-4.  As age increased, the percent of females that had at least 1 pregnancy increased from 14% (>14 years of age) to 47% in the 14 and 15 year old group to 61% among those 16 years of age older. The percent with at least one pregnancy charge increased with the number of living arrangements from 21% with one placement experience to 54% among those with 5 or more placements. Older age (OR=1.4, CI 1.4-1.5), being African American (1.4, CI 1.2-1.6), and having an increased number of placements (2.3, CI 1.8-2.8) were all associated with increased odds of becoming pregnant or delivering a baby during the study period.

 Conclusions & Implications: New Strategies to decrease early pregnancy among foster care youth (i.e. sexual risk taking behaviors that lead to early pregnancy) and increased access to preventive health care (i.e. contraceptive care) are needed. Implications for policy and practice include the need to ensure foster care youth have access to comprehensive pregnancy prevention services, such as sex education and family planning programs, and for those that become pregnant, access to routine prenatal care and timely post-natal follow up.