Adolescent pregnancy, infant mortality, and source of payment for birth: Alabama residential live births, 1991-1994

Purpose: To assess potential impact of programs to prevent adolescent pregn ancy on infant mortality. Methods: Infants (n = 247,503) born alive to Alabama residents from 1991 to 1994 were identified from birth cohort files and linked to infant death re cords. Deliveries funded by Medicaid, private insurance, and self-payers we re studied separately. Relative risks (RR) and population attributable risk s were calculated. The latter provided estimated percentages by which infan t (<1 year) death risks would have decreased if adolescent (less than or eq ual to 19 years) pregnancies had been prevented. Results: Infants of mothers < 16 years of age were at higher risk of death than were infants of mothers aged 20 to 34 years (adults): the RRs were 4.1 , 3.4, and 1.4 for self-payers, private insurance, and Medicaid groups, res pectively. In the self-payer and private insurance groups, but not the Medi caid group, infants of mothers aged 17 to 19 years were more likely to die than were infants of adults. Infants from repeat adolescent pregnancies com prised nearly one-third of all infants born to adolescents, and in each pay er-group were more likely to die than were infants of adults: The RRs were 4.9, 2.5, and 1.3 for self-payers, private-insurance, and Medicaid groups, respectively. Theoretically, preventing all adolescent pregnancies and prev enting only repeat adolescent pregnancies would have reduced infant mortali ty in the total population by 8% and 4%, respectively. Conclusions: Programs to prevent first and sub sequent adolescent pregnanci es probably have little effect on infant mortality. Efforts to prevent adol escent pregnancies should not have a short-term goal of notably reducing in fant mortality. (C) Society for Adolescent Medicine, 2001.