Introduction
Despite a progressive decline in teen pregnancy rates
since 1991, the United States has the highest rate of teenage
pregnancies and births among industrialized nations.1,2
Repeat teen births, although decreased in number over
the past 2 decades,3,4 continue to account for 18.3% of total
births to teen mothers.3 A disproportionate number of these
repeat births are experienced by low-income nonwhite
teenagers.5,6
Teen childbearing is associated with adverse health,
educational, economic, and developmental outcomes for
mother and child.7 Each additional child is thought to
compound these negative implications.8,9 Having multiple
children might reduce educational achievement for the
mother and children and decrease the mothers' economic
self-sufficiency.9e11 Adolescents who experience a repeat
birth within 2 years of the index child are more likely to
exhibit parenting stress and neglectful behavior12; children