Teen birth rates of those who have experienced substantiated maltreatment

Date Published

Noll, J., & Shenk, C. (2013). Teen Birth Rates in Sexually Abused and Neglected Females. Pediatrics. 131(4), 1181-1187.

Reviewed by
Rachael Lefebvre
Wendy Rha

Although recent years have seen a decline in the US teen birthrate, it remains the highest amongst industrialized nations. This prospective, longitudinal cohort study, conducted from 2007 to 2012, examined whether experiencing maltreatment placed females at higher risk for teen childbirth.

Adolescent females (aged 14 to 17) who had never given birth to a child and experienced substantiated maltreatment in the previous 12 months were recruited from local child welfare agencies in the catchment area of a large urban children’s hospital in the Midwest region of the United States. Comparison females, matched on race, age, family income, and family constellation (single vs. two parent households) were recruited from an outpatient health center located within the hospital. Participants were assessed annually through to the age of 19 years. Teen childbirth was measured via self-report and births were confirmed using hospital delivery records. During the course of the study, if a participant in the comparison group reported maltreatment (which was confirmed using child welfare records), they were excluded from the final analyses. The final sample consisted of 435 female adolescents (266 maltreated, 169 comparison) which was a 97.5% retention rate.

During the course of the study, a total of 70 participants gave birth (54 in the maltreated group and 16 in the comparison group). Logistic regression was used reflect the degree of risk for teen childbirth associated with maltreatment. Maltreated females were twice as likely to experience teen childbirth after controlling for age (at study entry), family income level, minority status, degree of sexual activity, and contraceptive use. The examination of whether specific subtypes of maltreatment predicted teen birth rates were also assessed. After controlling for previously identified risk factors and any previous occurrences of maltreatment, sexual abuse and neglect at study entry were found to significantly increase the odds of a subsequent teen childbirth by 2.74 fold and 3.14 fold, respectively. 

Methodological notes

This study has much methodological strength, which includes its prospective cohort design, a demographically matched comparison group, use of child welfare services substantiation of maltreatment (to enhance fidelity of group membership), and use of medical records to confirm childbirths. Moreover, the use of risk factors for teen births common in the general population as control variables also contributes to the rigor of the study.

Despite its methodological strengths, the study also has its limitations. The authors indicated that in many cases, adolescents had experienced multiple maltreatment types yet were categorized based on a “primary designation”. Moreover, only substantiated cases of maltreatment were considered. The authors also noted that their findings could not be generalized to the Hispanic ethno-racial group, as Hispanic adolescents were not well represented in the study.  Lastly, the study focused on the outcome of teen child birth, and thus did not consider other pregnancy outcomes such as abortion or miscarriage.