The “kaleidoscope” of factors influencing urban adolescent pregnancy in Baltimore, Maryland

Existing intervention and prevention efforts for adolescent pregnancy focus primarily on individual-level approaches; however, there is an emerging expectation to include a more contextually based social-ecological approach. This approach is salient in urban communities like Baltimore, Maryland, with one of the nation’s highest adolescent pregnancy and birth rates. Poverty, community violence, and compromised school systems further complicate the precursors and consequences of adolescent pregnancy. In this mixed methods study, we conducted interviews with key informants (n = 16) from community-based organizations, health departments, foundations, the public school system, clinics, and the faith community who worked with youth in Baltimore to gain a more comprehensive perspective on factors affecting adolescent pregnancy. Interviews were digitally recorded, transcribed verbatim, and analyzed using the constant comparative method. Geographic maps of select socio-demographic variables were created to examine the community context. Results highlighted contributing multi-level factors that emerged across the social-ecological model. Key informants described community- (e.g., environment, community norms, public policy; “Teen pregnancy is norm in many communities”), interpersonal- (e.g., peer social norms; “If you don’t perceive that you have a whole lot of options, you might just kind-of do what everybody else does”), and intrapersonal-level (e.g., specific developmental phase, self-esteem; “You need somebody to love and somebody to love you back”) influences on adolescent pregnancy and birth. GIS maps further illustrated disparities in adolescent birth rates, poverty level, and available community resources. Key informants recommended institutional and structural changes in the community, such as improving sexuality education and school-based health centers and increasing inter-organizational collaboration. These findings underscore the importance of considering creative community partnerships that address key social determinants of reproductive health in developing interventions to address adolescent pregnancy.