Examining the Impact of the Affordable Care Act on the Teen Birth Rate, Access to Care, and Cesarean Section Births in Pennsylvania.

Study objective: The teen birth rate in the United States has been relatively higher than in other developed countries. Given the complexity of this issue, this study aimed to use state-level birth data to examine changes in teen birth rates, access to care, and birth outcomes in pregnant teenagers before and after implementation of the Affordable Care Act (ACA).

Methods: This is a retrospective cross-sectional study of births to mothers aged 13-19 in Pennsylvania between 2008 and 2012 (pre-ACA) and 2015 and 2018 (post-ACA).

Results: A total of 52,180 pre-ACA and 21,994 post-ACA births were included in this study. The mean age at birth increased from 17.9 years to 18.0 years from the pre- to post-ACA period. The overall teen birth rate declined from 10.0% to 5.0%, a 50% reduction. The largest decrease in teen births from pre-ACA to post-ACA was seen in the non-Hispanic Black population, whose teen birth rate declined by 55%. There was also an increase in Medicaid-paid births and in first trimester prenatal care and a reduction in Cesarean sections from the pre-ACA to post-ACA period.

Discussion: Overall, our findings indicate that the implementation of the ACA contributed to decreased teen birth rates in Pennsylvania and reduced racial disparities in the incidence of teen births. This decline and improved prenatal care usage point to how the implementation of comprehensive sexual education and improved access to care through the ACA promote maternal health and prevent births for young women.