In 2022, the birth rate for teenagers ages 15 to 19 in the United States was 13.6 births per 1000.1 Although the teen birth rate has been declining, data shows that it is highly associated with poverty and neglect.2 Nearly 1 in 3 (28.8%) teenagers with a history of both living in poverty and reported child abuse and/or neglect have been pregnant at least once by the age of 17 years.2 Data shows a dose-response relationship between the number of adverse childhood experiences (ACEs) and the rate of teenage pregnancy.3 Teenage mothers are more likely to live in socioeconomically disadvantaged neighborhoods, experience depression, and have higher rates of substance use during pregnancy compared to adult mothers.4 Several other factors are associated with a high risk of teenage pregnancy such as early menarche, and substance use.4,5

Studies have shown a link between teen births and adverse pregnancy outcomes including preterm birth, low birthweight, low Apgar score, anemia, preeclampsia, hypertensive disorders, long-term morbidity, and fetal death.6 Multiple studies have investigated associations between race and ethnicity and infant outcome and found that non-Hispanic black and Hispanic teenage mothers are at a higher risk of giving birth to infants of extreme prematurity.7 While infant mortality is highest among non-Hispanic black infants, this racial disparity ceases when the mother is less than 15 years old.8

West Virginia (WV) is a predominantly white rural Appalachian state with high rates of teen births, poverty, lower educational attainment, and substance use in pregnancy.9 According to the National Center for Health Statistics (NCHS) data for 2022, WV has the 9th highest teen birth rate in the United States (U.S.).10 Despite falling rates of teenage pregnancy in the U.S. there is a disproportionate burden of teenage births in rural regions. Data from 2021 showed that 65,530 women of reproductive age in WV live in contraceptive deserts, and of those one third live in counties without a single health center that provides the full range of contraceptive methods. The purpose of the study was to provide the most current data on teen birth rates in WV, identify sociodemographic and lifestyle characteristics associated, and examine the relationships between teen births and adverse birth outcomes in this rural state.