To the extent that infants born to adolescents need more health care services than babies born to older mothers, a study of South Carolina infants enrolled in fee-for-service Medicaid suggests that the disparity may be attributable to differences in maternal characteristics, rather than to teenage mothers’ inability to obtain proper care for their children.1 In each of the first two years of life, rates of use of five of six types of care were higher among babies born to teenagers than among those born to older women. The pattern was the same when infant and delivery characteristics were controlled for, but few significant differences remained in analyses that took maternal characteristics into account.
The study used statewide data that linked Medicaid claims with birth certificate files for infants born in 2000–2002. Only healthy infants who were delivered at term, had a normal birth weight and were continuously enrolled in a fee-for-service plan from age two months through two years were included. These criteria yielded a sample of nearly 42,000 infants—about 4,000 whose mothers were teenagers (i.e., 11–17 years old) at delivery and 38,000 whose mothers were 18 or older.
In separate analyses for each of the first two years of life, researchers assessed infants’ use of six types of health service: doctor visits for preventive care, doctor visits for illness, emergency department visits, hospital admissions, and both emergency department visits and hospital admissions for conditions that are treatable on an ambulatory basis (e.g., asthma, seizures and gastrointestinal infections). Differences by maternal age at delivery were examined in bivariate and multivariate models.
Chi-square and t tests revealed significant—although generally small—differences in a wide range of maternal, infant and delivery characteristics according to the mother’s age at delivery. Most notably, teenage mothers had had less schooling than older women (9.8 vs. 11.8 years, on average), were less likely to be married (7% vs. 20%) and were more likely to have given birth only once (91% vs. 35%). They also were less likely to have received adequate prenatal care, as measured on a standard index (53% vs. 64%).
On average, the number of doctor visits for illness did not differ by maternal age at delivery in either year; however, in each year, teenagers’ babies made greater use of every other health service examined than did infants born to older women. They made 5–6% more preventive medical visits than other infants and had 9–17% more hospital admissions, 20–24% more hospital admissions for conditions that can be managed through ambulatory care, and 33–36% more emergency department visits in general and for conditions that were treatable on an ambulatory basis.
In analyses that controlled for infant and delivery characteristics, these findings were largely unchanged; the exception was that a marginally significant result suggested that infants born to teenagers made slightly more doctor visits due to illness than other babies during the first year. By contrast, when maternal characteristics were controlled for, maternal age was associated with differences in only two outcomes and only during the first year: Infants born to teenagers again had marginally more doctor visits because of illness than other infants, and they had 27% more hospital admissions for conditions treatable by ambulatory care. Results were similar when infant, delivery and maternal characteristics were controlled for simultaneously. In the full model, during the first year, babies born to teenagers made 8% more sick-infant doctor visits than children of older mothers (a marginally significant difference), had 9% more hospital admissions and had 29% more admissions for conditions that could be managed through ambulatory care.
According to the analysts, despite data limitations that restrict the generalizability of the results and may lead to certain biases, the findings suggest that health problems among infants of adolescent mothers reflect mothers’ socioeconomic disadvantage, rather than an inherent inability of young mothers to care for their children. Thus, “policies that aim to provide additional social support to adolescent mothers or additional financial resources may be useful ways to improve the health outcomes of infants who are born to younger women.”
1. Pittard WB, III, Laditka JN and Laditka SB, Associations between maternal age and infant health outcomes among Medicaid-insured infants in South Carolina: mediating effects of socioeconomic factors, Pediatrics, 2008, 122(1):e100–e106.