Health Insurance

Pregnant Minors 2.5 Times Less Likely to Receive Prenatal Care Than Pregnant Adults

Pregnant Minors 2.5 Times Less Likely to Receive Prenatal Care Than Pregnant Adults

Separately, the rate of pregnant minors who receive prenatal care in the first trimester is about a third lower than pregnant adults.
A positive pregnancy test.
A positive pregnancy test. Source: Getty Images

The teen birth rate in the U.S. has long been on the decline. There were 16.7 births per 1,000 teens ages 15 to 19 in 2019, down from 61.8 in 1991.

Experts attribute more teens using birth control as a potential reason for the decline. After the overturning of Roe v. Wade in June 2022, however, many states restricted access to abortions, and Supreme Court opinions indicate that access to contraception may be next — which may disrupt the decades-long decline of teen birth rates.

In light of this, ValuePenguin researchers analyzed Centers for Disease Control and Prevention (CDC) data to discover birth and maternal outcomes. The data shows that pregnant minors 17 and younger are 2.5 times less likely to receive prenatal care than pregnant adults. And pregnant minors and their babies are more likely to have medical complications.

Key findings

  • 4.2% of babies born to pregnant minors didn’t receive prenatal care — a rate 2.5 times greater than babies born to pregnant adults (1.7%). Nevada (9.2%) had the highest rate of underage births without prenatal care, followed by Hawaii (7.3%). On the other hand, Connecticut (1.4%) had the lowest rate, while West Virginia and Oregon tied for second-lowest (1.9%).
  • Just over half (51.5%) of babies born to pregnant minors received prenatal care during the first trimester, compared to over three-quarters (75.8%) of babies born to pregnant adults. West Virginia, Idaho and Kentucky had the highest first trimester prenatal care rates for underage births at 64.7%, 63.8% and 62.2%, respectively. They’re also the three states with the smallest gap between the rates of births by adults and minors that received prenatal care in the first trimester.
  • Underage mothers were more likely to receive government support. Overall, 79.2% of births to minors were covered by Medicaid, compared with 41.7% of births to adults. Additionally, 71.6% of minors were Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participants, compared with 35.2% of adults.
  • Pregnancies for minors were more likely to result in medical complications. Nationally, minors were 8.6% more likely to deliver a preterm baby and 28.6% more likely to suffer an injury such as a perineal laceration or a ruptured uterus.
  • Additionally, babies born to pregnant minors had worse outcomes in almost every category analyzed. Babies born to pregnant minors were 26.9% more likely to have a low birthweight, 41.6% more likely to have a five-minute Apgar below 7 and 7.3% more likely to require immediate intervention such as ventilation or antibiotics.

What births did we include in our analysis?

To determine what birth experiences minors are having across the U.S., ValuePenguin researchers used U.S. Centers for Disease Control and Prevention (CDC) data to analyze their birth outcomes and compared them to those of adult women.

Researchers first analyzed the frequency of births with no major complications, as a percentage of all births and as a percentage of births without particular risk factors.

To define births without major complications, researchers included the following factors:

  • The baby was delivered alive
  • The baby was delivered at 36 weeks or more, based on the obstetrician’s estimate of fetal maturity
  • The mother had a vaginal delivery
  • The baby’s birth weight was at least 2,500 grams
  • The baby’s 5-minute Apgar score — a standardized assessment for infant health after delivery — was at least a 7 on a scale of 1-10
  • The mother didn’t experience any morbidities during labor, such as an admission to an intensive care unit (ICU), a ruptured uterus or an unplanned hysterectomy
  • The baby had no abnormal conditions after birth, such as an admission to a neonatal intensive care unit (NICU) or seizures, and didn’t require treatments such as assisted ventilation or antibiotics for suspected neonatal sepsis

The major risk factors that were excluded from our analysis were:

  • Babies born in a breech position
  • Multiple births
  • Tobacco use by mother
  • Maternal infection, including gonorrhea, syphilis, chlamydia, hepatitis B and hepatitis C
  • Selected pregnancy risk factors, including diabetes and hypertension (regardless of whether the mother was diagnosed pre-pregnancy or during pregnancy), eclampsia, previous births with major complications (including preterm births and cesarean deliveries) or the use of infertility treatments.

Then, ValuePenguin researchers compared the rate of negative outcomes for all births (regardless of risk factors) between minors and adults.

Pregnant minors 2.5 times less likely to receive prenatal care

Among babies born to girls 17 and younger, 4.2% didn’t receive prenatal care, compared with 1.7% of babies born to adult women. That means pregnant minors were 2.5 times less likely to get prenatal care — and the percentage of minors lacking care was even higher than in other states.

Nevada, in particular, had the highest rate of underage births without prenatal care at 9.2%. Hawaii ranked second-highest (7.3%), followed by Georgia (6.9%). On the other hand, Connecticut had the lowest rate at 1.4%. West Virginia and Oregon tied for second-lowest at 1.9%.

According to ValuePenguin health insurance expert Robin Townsend, minors may feel safer seeking medical support in states with better access to it.

"Underage mothers are more comfortable seeking help where they feel supported by family and community," Townsend says. "That’s particularly true in states with better access to prenatal and maternal services, where an underage girl has a better chance at getting the medical care she needs."

In fact, when comparing these rankings to a previous ValuePenguin study on states with the best access to prenatal and maternal care, there are several notable similarities. The prior study found that 84.4% of all births in Connecticut had adequate prenatal care, making it the fourth-highest ranking state. Iowa — which had the ninth-highest rate of underage births with prenatal care in this study — ranked just behind Connecticut in the earlier study, with 84.1% of all births receiving adequate care.

On the other hand, the prior study found that just 60.3% of all pregnant women in Hawaii received similar care — the lowest of any state. New Mexico and Florida, two states with the lowest rates of underage births with prenatal care, also ranked among the bottom five states for adequate prenatal care in the earlier study.

Full rankings: States with the highest percentages of underage births with no prenatal care

Rank
State
% of underage births that didn’t receive prenatal care
1Nevada9.2%
2Hawaii7.3%
3Georgia6.9%
4Texas6.2%
5New Mexico6.1%
6Arizona5.9%
7New Jersey5.2%
8Florida5.1%
8Maryland5.1%
10Delaware5.0%
11Colorado4.6%
12Illinois4.3%
Show All Rows

Source: ValuePenguin analysis of Centers for Disease Control and Prevention (CDC) data. States with fewer than 500 babies born to minors were excluded from our state-level analyses.

51.5% of pregnant minors received prenatal care during the first trimester

There’s also a disparity between minors and adults who received prenatal care during the first trimester. While 51.5% of babies born to pregnant minors received prenatal care in the first trimester, 75.8% of babies born to pregnant adults received similar care.

Those percentages also varied by state. West Virginia had the highest rate of first trimester care among minors at 64.7%. That’s followed by Idaho (63.8%) and Kentucky (62.2%). Not only were minors more likely to receive care in these states, but they’re the three states that had the smallest gap between the rate of first-trimester prenatal care by adults and minors:

States with highest rates of first trimester prenatal care among underage pregnancies

Rank
State
% of underage pregnancies with first trimester prenatal care
% of adult pregnancies with first trimester prenatal care
Difference (points)
Difference (%)
1West Virginia64.7%78.4%-13.7-17.4%
2Idaho63.8%80.5%-16.7-20.7%
3Kentucky62.2%76.0%-13.8-18.1%

Source: ValuePenguin analysis of CDC data

Meanwhile, New Jersey ranked lowest for the rate of minors who received prenatal care in the first trimester (39.2%), followed by Maryland (40.4%). Hawaii also ranked among the lowest here, with 40.7% of minors receiving prenatal care in the first trimester. Similar to the states with the highest prenatal care rates, these three states had the largest gap between the rates of first trimester prenatal care by adults and minors:

States with lowest rates of first trimester prenatal care among underage pregnancies

Rank
State
% of underage pregnancies with first trimester prenatal care
% of adult pregnancies with first trimester prenatal care
Difference (points)
Difference (%)
1New Jersey39.2%75.6%-36.4-48.1%
2Maryland40.4%70.7%-30.3-42.9%
3Hawaii40.7%70.5%-29.8-42.3%

Source: ValuePenguin analysis of CDC data

Underage mothers more likely to receive Medicaid, WIC benefits

While prenatal care rates were lower among minors, these mothers were more likely to receive government support. Overall, 79.2% of births to underage mothers were covered by Medicaid, compared with 41.7% of births to adults. Minors were also more likely to participate in WIC, a supplemental nutrition program for women, infants and children. In fact, 71.6% of these mothers were WIC participants, compared with 35.2% of births to adult women.

According to Townsend, that gap likely boiled down to differences in eligibility. "Medicaid and WIC are open to pregnant women and teens within a certain income range," she says. "And since teens generally have low or no income, most who are pregnant qualify for both programs."

It’s also likely minors don’t receive as much financial support from family. Higher teen birth rates occur in areas with higher unemployment rates, lower average incomes and lower education levels — meaning that seeking government assistance may be necessary for many pregnant minors.

Because Medicaid offers retroactive eligibility, it’s difficult to say whether women and girls had coverage before giving birth, even if the birth itself was covered. However, access to WIC may indicate that minors could seek assistance during pregnancy — likely with the help of an adult.

Underage births most likely to receive Medicaid coverage in Louisiana, Mississippi

While Medicaid can offer some crucial relief among minors without health insurance, the coverage rate varies by state.

Generally, Medicaid coverage for underage births was highest in states where minors were least likely to have other insurance. Underage births were most likely to be covered by Medicaid in Louisiana (94.3%), Mississippi (91.2%) and Oklahoma (85.6%) — three states that also have among the highest rate of uninsured Americans, according to an earlier ValuePenguin study on uninsurance rates. Mississippi, in particular, has the highest uninsured rate in the U.S. at 14.4%.

Meanwhile, the states that had the lowest rate of underage births covered by Medicaid were Utah (62.2%), Massachusetts (64.9%), and Kansas (68.2%). Regarding their uninsured rates, each falls in the better half of the rankings. Notably, Massachusetts has the sixth-lowest rate of uninsured adults at just 4.3%.

Full rankings: States with the highest percentage of underage births covered by Medicaid

Rank
State
Underage births covered by Medicaid
1Louisiana94.3%
2Mississippi91.2%
3Oklahoma85.6%
4South Carolina84.8%
5Washington83.1%
6Iowa83.0%
7Alabama82.5%
8Tennessee82.2%
9North Carolina82.1%
10Arizona82.0%
11Georgia81.7%
11Oregon81.7%
Show All Rows

Source: ValuePenguin analysis of CDC data

Pregnancies (and births) for minors more likely to result in medical complications, poor outcomes

Pregnancies were more likely to impact the health of minors and their children. Compared to adults, pregnant minors are:

  • 148.1% more likely to not receive prenatal care.
  • 28.6% more likely to suffer an injury such as a perineal laceration or ruptured uterus.
  • 8.6% more likely to deliver a preterm baby.

Underage births had worse outcomes in almost every category analyzed. Notably, babies born to minors were 26.9% more likely to have a low birthweight (under 2,500 grams) and 7.3% more likely to require immediate intervention, such as ventilation or antibiotics.

Additionally, they were more likely to receive a poor score on their five-minute Apgar test, a standardized assessment for infant health after delivery. Compared to babies born to adults, those born to minors were 41.6% more likely to have a five-minute Apgar under 7, indicating abnormal to poor health.

The physical impact of pregnancy could play a role. According to a study published by the National Institutes of Health (NIH), the best time for pregnancy and childbearing is likely between the ages of 20 and 35, when the body is better equipped to handle the physical stress of pregnancy and birth.

There was some good news, though, as not all outcomes were poorer among minors. Specifically, minors had a lower rate of C-section delivery (17.1% versus 32.0%) and NICU admissions (9.6% versus 11.0%).

Risk factors also play a role in the high rate of poor outcomes among pregnant minors. While 34.8% of births by minors had no major complications, when we removed those with risk factors from the analysis (such as tobacco use, diabetes, a previous C-section, multiple births and eclampsia), the rate of complication-free births rose to 46.5% of pregnant minors. That’s comparable to the 47.3% of adults who didn’t experience complications during birth.

Support during pregnancy: Where to look and what to expect

Regardless of one’s age or sense of preparedness, pregnancy is undoubtedly difficult. For many, seeking medical support might’ve felt challenging even before abortion and birth control were hot-button issues. Although some states have restricted access to birth control and family planning services, Townsend says their support systems aren’t gone.

"While Planned Parenthood clinics have suspended certain services in some states, facilities are still open and available to provide counseling and health care," Townsend says. "You can also get help and guidance from a federally funded community health center, a local community center or a private doctor who accepts Medicaid."

Recent legislation also offers some hope for pregnant women seeking support. As of July 26, 2022, states and the District of Columbia have expanded Medicaid and Children’s Health Insurance Program (CHIP) coverage, increasing postpartum coverage from 60 days to 12 months. Townsend is hopeful that the extension will be adopted nationwide.

"If all states adopted the extension, about 720,000 people in the U.S. could be guaranteed Medicaid and CHIP coverage after pregnancy," Townsend says.

Meanwhile, community-based programs can offer additional assistance. That includes the CDC’s Quality and Access for Reproductive Health Equity for Teens (QARE for Teens) project, which provides greater access to reproductive health services for youth in at-risk areas.

Methodology

Analysts analyzed live births data in the U.S. from 2016 through 2020 via the CDC Wonder portal.

Pregnant minors were younger than 18 at the time of birth and adults were 18 and older. States with fewer than 500 babies born to minors were excluded from our state-level analyses but included in the national-level analyses. Those states were Alaska, District of Columbia, Maine, New Hampshire, North Dakota, Rhode Island, Vermont and Wyoming.

A birth without a major complication is defined here as:

  • The baby was delivered alive
  • The baby was delivered at 36 weeks or more, based on the obstetrician’s estimate of fetal maturity
  • The mother had a vaginal delivery
  • The baby’s birth weight was at least 2,500 grams
  • The baby’s 5-minute Apgar — a standardized assessment for infant health after delivery — score was at least a 7 on a scale of 1-10
  • The mother didn’t experience any morbidities during labor, such as an admission to an intensive care unit (ICU), a ruptured uterus or an unplanned hysterectomy
  • The baby had no abnormal conditions after birth, such as an admission to a neonatal intensive care unit (NICU) or seizures, and didn’t require treatments such as assisted ventilation or antibiotics for suspected neonatal sepsis

The major risk factors that we excluded as part of our analysis were:

  • Babies born in a breech position
  • Multiple births
  • Tobacco use by mother
  • Maternal infection, including gonorrhea, syphilis, chlamydia, hepatitis B and hepatitis C
  • Selected pregnancy risk factors, including diabetes and hypertension (regardless of whether the mother was diagnosed pre-pregnancy or during pregnancy), eclampsia, previous births with major complications (including preterm births and cesarean deliveries) or the use of infertility treatments (including fertility-enhancing drugs and assisted reproductive technology)