Adolescent Childbirth in a High-Risk Population: Predictors of First Birth Among Female Foster Youth

Background and Purpose: 
Despite the fact that adolescent birth rates in the United States have been in significant decline over the last seven years, previous research has not found an analogous decline in birth rates among girls in foster care. Given the multi-layered and cumulative risk factors associated with placement into foster care and the well-documented relationship between these characteristics and the likelihood of teen pregnancy or childbirth, girls in foster care appear to be a population at higher risk for early parenting. Yet, there is relatively little research to identify the girls in foster care who are most vulnerable and the experiences in care that are associated with giving birth as an adolescent.

Methods: To determine the experiences and characteristics associated with adolescent birth, this analysis used a longitudinal, population-based dataset constructed by probabilistically matching California child protective service records for female foster youth to maternal information available on vital birth records for children born between 2001 and 2010. Rates of childbirth among adolescent girls who entered foster care between the ages of 10 and 17 were generated and differences were assessed using chi-square test statistics with respect to demographic characteristics (age at entry, race/ethnicity), maltreatment history (maltreatment types and chronicity), and trajectories in foster care (reasons for removal, placement type, placement stability, length of stay, and history of running away or behavioral difficulties). Hazard models were specified to assess the rate of childbearing and findings are reported as both crude and adjusted hazard ratios with corresponding 95% confidence intervals.

Results: Among the 24,485 girls who entered foster care as adolescents in California, 19.5% (4,768) gave birth for the first time before their 20^th birthday. At a bivariate level, significant differences (p<.001) in birth rates were observed across demographic characteristics, maltreatment history, and foster care placement experiences. The highest birth rates were observed among adolescents who: entered care between the ages of 13 and 14 (23.0%); were Latina (23.5%); experienced recurrent incidents of substantiated maltreatment (23.3%); had high levels of placement instability (24.9% among those with 9 or more placements); were living in congregate care at the estimated date of conception (25.4%); and had a history of running away (27.7%). In the fully adjusted survival model accounting for maternal age at first birth, younger age at entry to care (ages 10-14), race/ethnicity (Latina and Black), placement in congregate care at the estimated date of conception, and a history of running away significantly predicted higher adolescent birth rates in this population. 

Conclusions and Implications: The results of this analysis suggest that there are identifiable risk factors associated with early childbirth among an already high-risk population of adolescents. Younger teens, those who have run away from their placements, and those who are (or are at risk of being placed) in congregate care appear to be more likely to give birth. This information can be useful in determining the timing and location of reproductive health and preventive services in order to minimize unintended pregnancy and maximize positive development and well-being.