ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Social Pediatrics
This article is part of the Research TopicHealthcare and Child Protection Synergy: Preventing Maltreatment and Promoting WellbeingView all 3 articles
Pregnancy and Reproductive Health Care Among Adolescent Females in the Child Welfare System
Provisionally accepted
- 1Washington University in St Louis, St. Louis, United States
- 2The Pennsylvania State University - University Park Campus, University Park, United States
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Objective: This study examines the prevalence and predictors of first pregnancy and Long-Acting Reversible Contraceptives (LARCs) among female adolescents aged 12 to 17 involved with the child welfare system. Methods: The study leverages linked longitudinal administrative data from the child welfare, juvenile legal, and Medicaid claims systems from Pennsylvania. The sample is 28,016 females born 2000 to 2005 who received Medicaid and were involved with the child welfare system during adolescence. Survival analysis is used to predict onset of first pregnancy and uptake of LARC. Results: Seventeen percent of adolescents became pregnant by age 18, with 18% having a health care encounter to receive a LARC. Foster care placement was not associated with pregnancy but was associated with increased use of LARCs. Substance use disorder, juvenile legal involvement, and recent suspected sexual abuse victimization were positively associated with pregnancy. There was a reciprocal association between LARCs and pregnancy: although any previous encounter for a LARC was negatively associated with pregnancy, uptake of LARCs also increased following a pregnancy. Conclusions: Despite broad declines in teen pregnancy over time, female adolescents with exposure to sexual abuse or engagement in substance use and delinquency face persistently high risk for very early pregnancy. Coordination between medical providers and child welfare agencies to address the sexual and reproductive health needs of at-risk teens is needed.
Keywords: Child Welfare, Pregnancy, Reproductive Health, foster care, adolescence
Received: 18 Sep 2025; Accepted: 17 Nov 2025.
Copyright: © 2025 Font, De Araujo Silva and Jones. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sarah A Font, font@wustl.edu
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