Health insurance coverage predicts lower childbearing among near-poor adolescents.
OBJECTIVE
The impact of health insurance on adolescent childbearing takes on increased salience in the context of the ongoing United States health care debate. Health insurance coverage is important for accessing health care services, including reproductive health services, yet prior research has not examined the association between insurance coverage and childbearing. Consequently, the role of insurance in the prevention of adolescent childbearing has been unclear.


METHODS
Using three panels (2001, 2004, and 2008) of the nationally representative Survey of Income and Program Participation data, hierarchical multilevel logistic regression models test the association between pre-pregnancy health insurance coverage and childbearing for a sample of 7,263 unmarried adolescent women (aged 16-19 years), controlling for known correlates of adolescent childbearing. Analyses examine variations in the association based on family income.


RESULTS
The odds of reporting childbearing were almost twice as great for adolescents who were uninsured compared with those who were insured before a pregnancy occurred. Interaction models demonstrate this effect for near-poor adolescents (who are less likely to have health insurance coverage) compared with poor and more advantaged adolescents.


CONCLUSIONS
The findings of the current nationally representative study suggest that health insurance coverage is associated with a lower probability of childbearing for near-poor adolescents. Future research should examine potential mechanisms through which insurance coverage influences adolescent childbearing.
Population Research Institute, Pennsylvania State University, University Park, Pennsylvania; Prevention Research Center, Pennsylvania State University, University Park, Pennsylvania; Department of Human Development and Family Studies, Pennsylvania State University, University Park, Pennsylvania. Electronic address: jac705@psu.edu.
Jacqueline A
JA
Miller
Deborah R
DR
Graefe
Gordon F
GF
De Jong
D000293:Adolescent; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D011203:Poverty; D011247:Pregnancy; D011253:Pregnancy in Adolescence; D034121:Reproductive Health Services / Q000191:economics; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
Adolescent childbearing; Fertility; Health insurance; Reproductive behavior