Number of births per 1,000 female population ages 15-19.
The 2019 County Health Rankings used data from 2011-2017 for this measure.
Reason for Ranking
Evidence suggests teen pregnancy significantly increases the risk of repeat pregnancy and of contracting a sexually transmitted infection (STI), both of which can result in adverse health outcomes for mothers, children, families, and communities. A systematic review of the sexual risk among pregnant and mothering teens concludes that pregnancy is a marker for current and future sexual risk behavior and adverse outcomes. Pregnant teens are more likely than older women to receive late or no prenatal care, have eclampsia, puerperal endometritis, systemic infections, low birthweight, preterm delivery, and severe neonatal conditions.[2, 3] Pre-term delivery and low birthweight babies have increased risk of child developmental delay, illness, and mortality. Additionally, there are strong ties between teen birth and poor socioeconomic, behavioral, and mental outcomes. Teenage women who bear a child are much less likely to achieve an education level at or beyond high school, much more likely to be overweight/obese in adulthood, and more likely to experience depression and psychological distress.[5-7]
Key Measure Methods
Teen Births is a Rate
Teen Births is the number of births to females ages 15-19 per 1,000 females in a county. Rates measure the number of events (i.e., deaths, births, etc.) in a given time period (generally one or more years) divided by the average number of people at risk during that period. Rates help us compare health data across counties with different population sizes.
Births are Counted in the Mother’s County of Residence
Births are counted in the county corresponding to the mother’s address on the child’s birth certificate, not the county the child was born in.
Some Data are Suppressed
A missing value is reported for counties with fewer than 10 teen births in the time frame.
The primary limitation of this measure is that it does not capture births among teens younger than 15. Teen births and teen pregnancy are distinct but related measures. Although all births are the culmination of a pregnancy, not all pregnancies culminate in a birth.
The numerator is the total number of births to mothers ages 15-19 in a 7-year time frame.
The denominator is the aggregate female population, ages 15-19, over the 7-year time period.
Can This Measure Be Used to Track Progress
This measure can be used to track progress with some caveats. It is important to note that the estimate provided in the County Health Rankings is a 7-year average. However, in most counties, it is relatively simple to obtain single year estimates from the resource included below.
Years of Data Used
National Center for Health Statistics - Natality files
Data on deaths and births were provided by NCHS and drawn from the National Vital Statistics System (NVSS). These data are submitted to the NVSS by the vital registration systems operated in the jurisdictions legally responsible for registering vital events (i.e., births, deaths, marriages, divorces, and fetal deaths). We requested this data for the first time for the 2018 Rankings. This was done because of the discontinuation of Health Indicators Warehouse. This change also allows to to perform additional analyses for state and national reports which if obtained from CDC WONDER would have numerous missing counties.
Counties can find the same data from CDC WONDER. However, we use the raw data files. CDC WONDER does not report data for all counties per their missing data criteria.
The methods for calculating the error associated with death rates can be found here:
For counties with fewer than 20 births a missing value for all values is reported.
For counties with between 20 and 99 births a gamma adjustment from the poisson distribution is used to calculate the CIs (see page 87: http://www.nber.org/mortality/2002/docs/techap99.pdf).
For counties with 100 births or more CIs are calulated according to the normal distribution. Standard errors (SE) and birth rates for each age group are calculated. These SEs are squared and multiplied by the square of the weights and then divided by the total number of births over all age groups. The sum of these provides the variance of the estimate for each county. The square root of the variance gives the standard deviation which is then used as estimate +/- 1.96*STDEV.
We recommend starting with the CDC Wonder database, which contains information on birth rates by race, ethnicity, age, gender, and geography of mother and child for counties with populations greater than 100,000. For counties with smaller populations, most states maintain databases of birth and death data. You can find links to these in State-Specific Data Sources.
Another way to access this data is through the Community Commons. Data by race can be found for some communities. Note that you will need to login to access this report, but registration is free for all.
 Meade CS, Ickovics JR. Systematic review of sexual risk among pregnant and mothering teens in the USA: Pregnancy as an opportunity for integrated prevention of STD and repeat pregnancy. Soc Sci Med. 2005;60:661-678.
 U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Child Health USA 2011. Rockville, Maryland: U.S. Department of Health and Human Services, 2011.
 Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, Yamdamsuren B, Temmerman M, Say L, Tunçalp Ö, Vogel JP, Souza JP, Mori R, on behalf of the WHO Multicountry Survey on Maternal Newborn Health Research Network. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG 2014; 121 (Suppl. 1): 40–48.
 Chandra PC, Schiavello HJ, Ravi B, Weinstein AG, Hook FB. Pregnancy outcomes in urban teenagers. Int J Gynaecol Obstet. 2002;79:117-122.
 Hoffman, S. D., & Maynard, R. A. (Eds.). (2008). Kids having kids: economic costs and social consequences of teen pregnancy (2nd ed.). Washington, DC: Urban Institute Press.
 Chang, T., Choi, H., Richardson, C. R., Davis, M. M. "Implications of teen birth for overweight and obesity in adulthood." American journal of obstetrics and gynecology 209.2. 2013: 110-e1.
 SmithBattle, L., Freed, P. "Teen mothers' mental health." MCN: The American Journal of Maternal/Child Nursing 41.1. 2016: 31-36.
See how this component fits into our model
When it comes to developing and implementing solutions to problems that affect communities, evidence matters. The strategies below give some ideas of ways communities can harness evidence to make a difference locally. You can learn more about these and other strategies in What Works for Health, which summarizes and rates evidence for policies, programs, and systems changes.