On Teenage Childbearing and Neonatal Mortality in the United States

In the United States, further reducing the incidence of infant mortality remains a highly desirable goal. Particularly acute is the need to reduce black infant mortality, which is approximately twice the rate for whites. 1 Because one feature of black American fertility patterns is a high rate of teenage childbearing, some have suggested that early fertility plays an important role in high rates of black infant mortality. Correspondingly, one policy view is that efforts to prevent teenage childbearing will also reduce infant mortality. The logic underpinning this policy approach is based on a common interpretation of the observed association between teenage childbearing and excessive infant mortality, namely, that early fertility is inherently detrimental to child survival. This article reconsiders that assumption and posits an alternative viewpoint: that teenage childbearing in a highly developed industrial country such as the United States is a social response to disadvantage, and that the excessive infant mortality associated with it is a consequence of the same disadvantage rather than of early fertility per se. Teenage motherhood in the United States occurs almost exclusively among socioeconomically disadvantaged populations, in which women at any age may be exposed to environmental factors that elevate infant mortality (Geronimus, 1986a). If environmentally induced risk factors are the primary explanation of the association between early fertility and excess infant mortality, then policy initiatives focusing directly on altering the childbearing behavior of teenagers will not reduce infant mortality. Furthermore, if environmental influences are more important than inherent biological factors, then fundamental questions arise regarding the possibility of extrapolating from US experience to countries, particularly less developed ones, with different population parameters and environmental considerations.