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Repeat Teen Births in the United States Cluster in Poorer Areas with More Limited Reproductive Health Care Access

Julie Maslowsky, Daniel Powers, C. Emily Hendrick, and Leila Al-Hamoodah


In 2017, 16.3% of the 194,377 births to U.S. teenagers ages 15-19 were to young women who have already had a child. Having more than one birth while a teenager is often referred to as “repeat” teen birth. Most births to teenagers, whether first or repeat, are unintended.

The sparse literature to date that has compared first-time and repeat teen mothers suggests that repeat teen mothers and first-time teen mothers differ in measures of socioeconomic background, socioeconomic attainment, and infant health. Young women who have repeat teen births are more likely to be a member of a racial/ethnic minority group, a high school drop-out, low-income, and unemployed compared to first-time teen mothers. In addition, repeat teen mothers are more likely to delay or forgo prenatal care and experience higher rates of preterm births, low birth weight, and infant mortality.

Strategies for the prevention of first-time and repeat teen births also differ. For example, improving general health care, primary teen pregnancy prevention programs and preconception contraceptive care can best help prevent first-time births. In contrast, prenatal health care access, postpartum contraceptive care, and other social services such as home visiting programs can better prevent repeat teen births. Examining the geographic clustering of first-time and repeat teen mothers illuminates unmet service needs and identifies opportunities for intervention.

Research on first-time and repeat teen mothers largely comes from international studies, smaller studies, or studies using data from the 1990s. To update this research, the authors use 2015-2017 birth certificate data from 629,939 births to teenagers in 3,108 counties in the contiguous 48 states to analyze geographic differences in rates of first-time and repeat teen births. The authors identify clusters of counties with significantly elevated rates of first teen births only, repeat teen births, both, or neither, and compare demographic, socioeconomic, and medical provider characteristics across the different types of clusters.

Understanding where repeat teen births occur, as well as documenting the demographic composition, socioeconomic conditions, density of health care providers, and availability of family planning services in these places, can inform both clinical practice and health services resource allocation on county and state levels.

Key Findings

  • Counties with high rates of first-time teen births and repeat teen births tend to cluster together and are not distributed evenly throughout the U.S. (See figure).
    • Counties with elevated rates of first-time teen births, repeat teen births, and both were concentrated in the South.
    • Clusters of counties with elevated first and repeat teen birth rates were also located in small-population areas in northern states and in areas with large Native American populations, among whom rates of repeat teen births are relatively high.
  • Counties in clusters with high rates of repeat teen births tended to be economically worse off than counties in clusters with elevated rates of first-time teen births only.
    • Counties with high repeat (versus first-only) teen birth rates had higher rates of poverty and unemployment, higher levels of income inequality, lower high school graduation rates, and a higher share of racial and ethnic minority residents.
    • These counties also have more women per capita receiving contraceptive services at publicly funded clinics but have fewer publicly-funded family planning clinics per capita.

Clusters of U.S. counties with elevated first and repeat teen births are concentrated in the South, Lower Midwest, Southwest and Southern California

This map shows counties that appeared in clusters of high first-time teen birth rates, high repeat teen birth rates, both, or neither. 

Policy Implications

These results reinforce the importance of considering whether a teen mother has had previous births in addressing her service needs. They further demonstrate a need to allocate resources and tailor teen pregnancy prevention programs to the types of teen births that are most common in each area. For example, areas with high rates of first-time teen moms could focus more resources on primary teen pregnancy prevention. Areas with elevated repeat teen birth rates, in contrast, may wish to increase access to immediate postpartum long-acting reversible contraceptives or home visiting programs, both of which are known to delay or reduce repeat teen pregnancies.


Maslowsky, J., Powers, D., Hendrick, C.E, & Al-Hamoodah, L. (2019). County-level clustering and characteristics of repeat versus first teen births in the United States, 2015-2017. Journal of Adolescent Health published online ahead of print;

Suggested Citation

Maslowsky, J., Powers, D., Hendrick, C.E, & Al-Hamoodah, L. (2019). Repeat teen births in the United States cluster in poorer areas with more limited reproductive health care. PRC Research Brief 4(8). DOI: 10.26153/tsw/2966.

About the Authors

Julie Maslowsky ( is an assistant professor of health behavior and health education, assistant professor of population health, and a faculty research associate in the Population Research Center at The University of Texas at Austin; Daniel Powers is a professor of sociology at UT Austin and a PRC faculty research associate; C. Emily Hendrick is an instructor in the Master of Public Health program at the University of Nevada-Reno. When the paper was written, Leila Al-Hamoodah was a graduate student in the LBJ School of Public Affairs. 


This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K01HD091416, T32HD049302) and a William T. Grant Foundation Scholars Award to Julie Maslowsky. Infrastructure support was provided by grant P2CHD042849 awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Contact Julie Maslowsky ( for Original Article.

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