Repeat Births Among California Adolescents Aged 19 Years and Younger (2010-2020)

Record declines in adolescent birth rates continue to occur nationwide and in California.^1–4 However, many young people have repeat live births (two or more live births before age 20) during their adolescent years.

Why are these data important?

Early repeat childbearing can carry high emotional, social, health, and economic costs to adolescents aged 10–19 and their children.^5,6 Having a child (or multiple children) as an adolescent can hurt a young parent's ability to finish school or take advantage of workforce opportunities.^7–10 Infants from repeat births are often born too small or too soon, and preterm births can lead to potential health problems for the children.^11,12 Unintended repeat births can be prevented using strategies that address parenting adolescents' broader needs, such as skills for life planning, goal-setting, and counselling about youth-friendly, postpartum, FDA-approved contraceptive methods.

Key Findings - Statewide

• The number and percentage of repeat births (PRB) to adolescents aged 19 and younger declined between 2010 and 2020:
• In 2010, 7,524 out of 43,528 live births to adolescents (17.3%) were repeat births.
• In 2020, 1,820 out of 13,692 live births to adolescents (13.3%) were repeat births.
• In 2010, the vast majority of repeat births to adolescents were for a second child (87.5%), 11.3% were for a third, and 1.2% were for a fourth or higher order birth.
• In 2020, the vast majority of repeat births to adolescents were for a second child (89.7%), 9.2% were for a third, and 1.0% were for a fourth or higher order birth.

Statewide By Age Group

• PRB among ages 17 and younger declined from 7.9% (2010-12) to 6.2% (2018-20).
• PRB among ages 18-19 declined from 21.1% (2010-12) to 16.6% (2018-20).

Figure 1. Percentage of Repeat Births among Adolescents by Age Groups and Years

• Year 2010-2012
  • 17 years and younger 7.9%
  • 18–19 years 21.1%
• Year 2018-2020
  • 17 years and younger 6.2%
  • 18–19 years 16.6%

Statewide by Race/Ethnicity

• Between 2010-12 and 2018-20, the PRB among American Indians/Alaska Natives ages 19 and younger declined from 21.9% (the highest across different race/ethnicity groups) to 14.8%, illustrating the highest percentage decline at 32.4%.
• Asians ages 19 and younger (15.9%) had the highest PRB in 2018-20, and they also experienced the lowest percentage decline in PRB between 2010-12 and 2018-20 at 5.4%.

Table 1. Repeat Births among Adolescents by Race/Ethnicity and Year

* AIAN=American Indian/Alaska Native.
** HI/PI=Hawaiian/Pacific Islander.
*** Interpret with caution as a very small number (n=10) of repeat births occurred in 2018–20.

Key findings – Region and County

Regionⁱ

• The San Joaquin Valley region, which had the highest PRB in both 2010–12 (19.1%) and 2018–20 (16.1%), experienced a 15.7% decline in PRB during this period.
• The Central Coast region had the largest decline in PRB at 24.3%. The PRB declined from 18.5% in 2010–12 to 14.0% in 2018–20.
• The Greater Sacramento region had the smallest PRB decline at 12.8%. The PRB declined from 15.6% in 2010–12 to 13.6% in 2018–20.

Countyⁱⁱ

• In 2018–20, PRBs varied widely across California's 58 counties.
• San Francisco County had the lowest PRB at 8.4%.
• Yuba County had the highest PRB at 19.6%.
• The highest PRB was 2.3 times that of the lowest PRB.

• Regions are groups of counties as defined by the California’s Maternal and Infant Health Assessment.
• Counties with fewer than 10 repeat births are excluded.

Figure 2. Percentage of Repeat births among adolescents ages 19 and younger by region and years

• Year 2010-2012
  • San Francisco Bay Area, 13.8%
  • San Diego County, 15.9%
  • North/Mountain, 15.1%
  • Greater Sacramento, 15.6%
  • Southeastern CA, 16.9%
  • Los Angeles County, 17.3%
  • Central Coast, 18.5%
  • Orange County, 16.9%
  • San Joaquin Valley, 19.1%
• Year 2018-2020
  • San Francisco Bay Area, 11.3%
  • San Diego County, 12.6%
  • North/Mountain, 12.7%
  • Greater Sacramento, 13.6%
  • Southeastern CA, 13.6%
  • Los Angeles County, 14%
  • Central Coast, 14%
  • Orange County, 14.1%
  • San Joaquin Valley, 16.1%

Public Health Implications

Remarkable reductions in adolescent birth rates and PRBs occurred in the last decade. However, in 2020, nearly 2,000 adolescents experienced repeat births and more than 200 of these repeat births occurred among young adolescents ages 17 years and younger. While PRBs declined across California regions, geographical disparities by county remain, with the highest county PRB being 2.3 times greater than the lowest county PRB.

Linking pregnant and parenting adolescents to services aimed at preventing unintended additional births is key to reducing repeat births in this population. MCAH programs, such as the California Home Visiting Program, the Adolescent Family Life Program, and the Adolescent Sexual Health Education Program, address a broad range of adolescents' needs, including providing information on counselling and postpartum contraception. Targeted prevention initiatives within areas with elevated PRBs could improve health and social outcomes for all birthing adolescents.

Methods

Data Sources

The following data sources were used in the development of this data brief:

• 2010–12, California Birth Statistical Master File. California Department of Public Health, Center for Health Statistics and Informatics.
• 2018–20, California Comprehensive Master Birth File. California Department of Public Health, Center for Health Statistics and Informatics.

To obtain more statistically stable estimates of PRB by demographic characteristics, region, and county-level, three-year aggregated (2010–12 and 2018–20) data were used. Even with these aggregated data, there are 15 counties for which the PRB was suppressed due to small numbers of repeat births (i.e., between 1 and 9).

Definition of Percentage of Repeat Births (PRB)

The PRB is defined as the number of individuals having two or more live births before 20 years of age, divided by the total number of live births, then multiplied by 100.

Definition of Regions

Regions are groups of counties as defined by California's Maternal and Infant Health Assessment (MIHA). Three regions are stand-alone counties: Los Angeles, Orange, and San Diego.  See map below. 

• Cental Coast Region - Monterey, San Benito, San Luis Obispo, Santa Barbara, Santa Cruz, Ventura
• Greater Sacramento Region - El Dorado, Placer, Sacramento, Sutter, Yolo, Yuba
• Los Angeles County
• North/Mountain Region - Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Inyo, Lake, Lassen, Mariposa, Mendocino, Modoc, Mono, Nevada, Plumas, Shasta, Sierra, Siskiyou, Tehama, Trinity, Tuolumne
• Orange County
• San Diego County
• San Francisco Bay Area - Alameda, Contra Costa, Marin, Napa, San Francisco, San Mateo, Santa Clara, Solando, Sonoma
• San Joaquin Valley - Fresno, Kern, Kings, Madera, Merced, San Joaquin, Stanislaus, Sonoma
• Southeastern California - Imperial, Riverside, San Bernadino

Table 2. Percentage of Repeat Births among Adolescents Ages 19 years and younger by County within Region, 2010–12 and 2018–20

* – data are suppressed to small numbers; numerator is less than 10 cases

References

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