Teen Pregnancy and Foster Care

The United States has one of the highest teen pregnancy and birth rates in the industrialized world,[1] some of the highest teen birth rates are found in the South.[2]  Birth rates are highest for Hispanic teenagers (4.6%) and Black teenagers (4.4%).[3]

Foster Care and Teen Pregnancy

Most teen parents are not married.[4] Although teen pregnancy rates have been declining in the U.S.

teen pregnancy

since 1990[2], teenage pregnancies among youth in foster care have reached epidemic levels. Teenage girls in the foster care system are twice as likely to get pregnant before turning 19 than teenage girls who are not in foster care. Many of these teenagers are pregnant again before the age of 19.[4] Why are these teens at such high risk for pregnancy? Teens in foster care are more likely to have suffered from child abuse, which can lead to physical and emotional health problems.[5]  The Guttmacher Institute speculates that the circumstances that led them to be placed in foster care in the first place, along with the experience of being in foster care, make this group especially vulnerable to teen pregnancy.

The foster care setting also creates a unique situation in which many adolescents do not have close family connections. A close parent-adolescent bond is shown to delay sexual activity, increase use of contraceptives and birth control, and decrease the risk of teen pregnancy.[5]

This lack of parent-adolescent bond, as well as the lack of information provided to these teens, makes teenagers in foster care more prone to engage in riskier sexual behaviors; almost 20% of youth in foster care reported first having consensual sex before the age of 13, compared to 8% in the general population. A teenage girl in foster care may become pregnant intentionally as a way of creating her own family. However, a young woman aged out of the foster system is more likely to experience financial hardships, such as inability to pay for rent or electricity, increasing the likelihood that her own children will be placed into the foster care system.[4]


There are a variety of factors that make targeting foster youth for pregnancy prevention interventions difficult. Many switch schools frequently or rarely attend school, which keeps them from participating in school-based sex education programs. The high turnover rate in caseworkers means foster adolescents often do not have help accessing primary care. This, in addition to changes in living arrangements, reduces the chances of easy access to a clinic or organization that provides reproductive health care and birth control. Moving from one foster home to another prevents girls from getting the sexual health information they need; a girl may develop a trusting relationship with an adult and potential role model, but then have to move again. Sometimes, the religious beliefs and practices of caseworkers and foster parents can also limit their ability to address sexual health issues and will prohibit young women from receiving the necessary information.

In September 2010, the Department of Health and Human Services announced that it would give $155 million in grants to states, non-profit organizations, school districts, universities, and other groups for the implementation of evidence-based teen pregnancy interventions. 75 different grantees implemented replications of 23 evidence based intervention programs, with some grantees utilizing a combination of models, taking into consideration the specific needs of their community. Additionally, the Affordable Care Act provided funding to replicate evidence-based teen pregnancy prevention models through the Personal Responsibility Education Program (PREP).

Prevention Programs

One example of a program that developed from the 2010 funding that was specifically designed for foster youth living in group homes is Power Through Choices. It is a 10-session educational program which empowers kids to prevent sexually-transmitted diseases and pregnancy. It uses group discussion, goal-setting, and role-playing to teach kids how to make healthy life choices. This program should serve as a potential model for organizations across the country that work with foster youth.[6]

The study was focused on asking questions about basic sexual health knowledge, as well as issues of how accessible this knowledge actually is. The program fostered increased support for safe sex and a greater sense of self-empowerment or self-efficacy to prevent unprotected sex.[7] Additionally, in a study published in 2015 which evaluated the program,  there were statistically significant improvements in the percentage of youth who received information about sexual health including, access to birth control, talking to a partner about sex and birth control, saying no to sex, methods of birth control, and sexually transmitted infections.[7]

The Bottom Line

Teenage girls in foster care urgently need access to educational programs, counseling, and health services to prevent teen pregnancy. Likewise, foster parents, caseworkers, and others who come into contact with these teens need special training. New information about the behaviors of girls in foster care will help develop effective pregnancy prevention programs and services. Still, continuous evaluations of existing programs coupled with adequate resources is essential to ameliorate this issue.

All articles on our website have been approved by Dr. Diana Zuckerman and other senior staff.

1. Kost K, Henshaw S, Carlin L. U.S. Teenage Pregnancies, Births and Abortions: National and State Trends and Trends by Race and Ethnicity: Guttmacher Institute; 2010

2. Hoffman S. By the Numbers—The Public Costs of Teen Childbearing. Washington, DC: National Campaign to Prevent Teen Pregnancy; 2006

3. Ventura, S., Hamilton, B., & Mathews, T. (2014). National and State Patterns of Teen Births in the United States, 1940-2013. National Vital Statistics, 63(4). Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr63_04.pdf

4. Courtney, ME., Dworsky, A., Ruth, G., Keller, T., Havlicek, J., Bost, N. (2005). Midwest Evaluation of the Adult Functioning of Former Foster Youth: Outcomes at Age 19. Chapin Hall Center for Children at The University of Chicago. Retrieved from http://www.chapinhall.org/sites/default/files/ChapinHallDocument_4.pdf

5. Boonstra, HD. (2011). Teen pregnancy among young women in foster care: a primer.Guttmacher Policy Review, 14(2), Retrieved from http://www.guttmacher.org/pubs/gpr/14/2/gpr140208.html

6. Becker, MG, & Barth, RP. (2000). Power through choices: the development of a sexuality education curriculum for youths in out-of-home care. Child Welfare, 79(3), Retrieved from http://www.eric.ed.gov/ERICWebPortal/search/detailmini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=EJ635691&ERICExtSearch_SearchType_0=no&accno=EJ635691

7. Goesling, Brian, Reginald D. Covington, Jennifer Manlove, Megan Barry, Roy F. Oman, and Sara Vesely. (2015). “Interim Impacts of the POWER Through Choices Program.” Princeton, NJ: Mathematica Policy Research.