By Lisa Rapaport

(Reuters Health) – More teenage girls and young women in rural communities become pregnant for the first time on purpose and carry first pregnancies to term, compared to their urban counterparts, a U.S. study suggests.

Both trends may reflect poorer access for rural teens and young women to family planning options, researchers conclude in the American Journal of Public Health.

The study team examined more than two decades of data on first pregnancies for teens ages 15 to 19 and young women ages 20 to 24. Overall, 25% of rural teens and 55% of rural young women planned their first pregnancies, compared with 21% of urban teens and 47% of urban young women.

Among teens with unintended first pregnancies, 74% in rural areas had live births compared with 63% in urban areas, the study also found. And among young women in their early 20s with unintended first pregnancies, 73% of rural women had live births compared with 54% of urban women.

Unintended first pregnancies were terminated by 7% of rural teens and 16% of urban teens, and by 6% of young women in rural areas, compared with 15% in cities.

“Urban-rural disparities are perhaps less tied today than in the past to individual sociodemographic factors,” lead study author April Sutton of the University of San Diego in La Jolla, California, and colleagues write.

“Issues such as geographic access and isolation in health care – including reproductive health care – may instead represent an important dimension of the new geography of exclusion,” Sutton and colleagues write. “For rural women, the long-run costs of unintended pregnancies seem most germane, especially because unintended child-bearing has negative consequences for educational attainment, earnings, and maternal and child health.”

Pregnancy outcomes also appeared to vary by race and location.

About 60% of rural black and Hispanic teens’ first pregnancies were unintended and ended with live births, compared with 45% of white teens’ pregnancies in cities, the study found.

Among rural black teens, just 4% of pregnancies were unintended and resulted in abortions, compared with 20% among urban black adolescents.

The proportion of unintended pregnancies ending in live births was similar for black urban teens and white rural adolescents, at 51% and 52%, respectively.

One limitation of the study is that it’s possible that some survey participants didn’t disclose abortions, leading to an overcount of the proportion of pregnancies resulting in live births, the study authors note.

Even so, the results underscore that differences in pregnancy outcomes and reproductive health options may contribute to health disparities between rural and urban women, the researchers conclude.

SOURCE: American Journal of Public Health, online October 17, 2019.