Structural Influences on Adolescent Pregnancy and Birth

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Background: Adolescent pregnancy and childbirth have been associated with adverse health and social outcomes for both adolescent mothers and their children. Although rates of adolescent pregnancy and birth have declined in high-income countries with increased access to effective contraception, rates in at-risk populations have not seen similar declines. Structural determinants of adolescent pregnancy, such as foster care involvement, contraception availability and affordability, and pregnancy prevention programming, may affect girls’ ability to make informed reproductive decisions, highlighting the need to move beyond individual-level analyses and examine structural influences on adolescent pregnancy. Aim: Thus, this dissertation aims to describe adolescent pregnancy and birth rates in at-risk populations, including girls in the foster care system and adolescent girls who have already had a pregnancy; and to explore the potential influence of structural determinants on adolescent pregnancy and birth rates, such as sexual health education curriculum, type of child welfare involvement, and transition-to-adulthood programming for adolescents in foster care. Methods: This dissertation includes three manuscripts examining adolescent pregnancy and childbirth in at-risk populations in Canada and the United States. We conducted a quantitative analysis of trends in adolescent rapid repeat childbirth using administrative data in a Canadian context, comparing maternal and neonatal outcomes from adolescent girls’ rapid repeat childbirth to their index childbirth. We conducted a systematic review and meta-analysis of adolescent pregnancy and birth in girls involved in the foster care system. Finally, we used the National Youth in Transition Database to analyze service use and impact for adolescent mothers emancipating from foster care in the United States. Results: We found that adolescent pregnancy and childbirth remain high among girls in foster care, and that repeat birth is common among adolescent girls who have already had one birth. We found evidence that structural determinants may impact adolescent childbearing, including access to contraception, access to services, and involvement in foster care. Conclusion: The findings of this dissertation highlight the health and social outcomes of adolescent childbirth for at-risk girls and the need for structural change to prevent adolescent childbirth and to support adolescent mothers and their children as they transition to adulthood.
adolescent pregnancy, child welfare system, structural determinants of health
Ramage, K. (2021). Structural Influences on Adolescent Pregnancy and Birth (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from