Understanding how communities impact adolescent childbearing

There’s been a downward trend in adolescents’ giving birth across states, age groups and racial ethnic groups since the 1990s. There are still some disparities, with certain geographic areas having higher rates, including those experiencing high levels of poverty. Most previous research on this trend has focused on changes at the individual level and didn’t account for geographic variation. New Bixby Center research aims to understand community-level factors associated with the substantial decline in adolescent births in California from 2000-2014. As the state with the largest adolescent population—and one that is racially, ethnically and geographically diverse—California provides an excellent case study.

The study looked at adolescent birth rates by Medical Service Study Areas, federally recognized geographic areas developed in California to identify medically underserved areas. MSSAs capture meaningful differences in neighborhoods that may be lost when looking at larger geographical areas like counties.

The researchers found that urban areas experienced a greater decrease in the adolescent birth rate than rural areas, which was consistent with previous research at the county level. Those differences were independent of changes in social, demographic and economic factors. They were, however, related to availability of long-acting contraception. It’s important to note that in addition to long-acting birth control, rural adolescents may have less access to all sexual and reproductive health services, including abortion, than adolescents in urban areas.

Communities where Family Planning Access Care and Treatment (FPACT) providers began offering long-acting reversible contraception experienced a significantly larger decline than those that did not offer these methods. FPACT provides publicly funded, confidential family planning services to low-income adolescents and adults. These results provide support for expanding access to the full range of contraceptive methods at low or now cost in all communities.

The researchers found a striking association between changes in neighborhood-level educational attainment and adolescent childbearing. The percentage of young adults attending college or graduate school increased dramatically over those 14 years. Increase in percentage of young adults who graduated high school was linked with significantly larger declines in childbearing. Across California, the adolescent birth rate has reached historic lows for all racial and ethnic groups, though disparities by race and ethnicity persist. The patterns suggest that existing policies and programs have helped youth of color prevent unwanted births. However, a broad range of structural, cultural and familial and individual factors contribute to patterns in both intended and unintended childbearing by race and ethnicity.

These results add to the growing recognition of the role community-level factors may play in adolescent opportunities and decision making. Identifying the contributions of these individual factors can help policymakers better refine and target their efforts and make them more responsive to the communities they serve.