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Obstetrics & Gynecology 2006;108:111-118
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Reproductive Health, Criminal Activity, and Abuse Among 10- to 15-Year-Old Females Enrolled in Medicaid

Bradford D. Gessner, MD, MPH1

From the Alaska Division of Public Health, Anchorage, Alaska.

OBJECTIVE: To quantify the degree of abuse or criminal behavior among young females presenting for reproductive health care services.

METHODS: An evaluation was conducted among Alaskan females age 10 through 15 years enrolled in Medicaid. Subjects were identified who had experienced reproductive health outcomes. The Medicaid file was linked to a Child Protective Services database and a Juvenile Justice database to identify episodes of abuse by a caretaker and criminal behavior.

RESULTS: Of 21,350 Alaskan females aged 10–15 years enrolled in Medicaid during 1999–2003, 841 (3.9%) presented for reproductive health care, 2,930 (14%) were referred to Child Protective Services and 1,858 (8.7%) were referred to Juvenile Justice for criminal activity. Among the subjects with a reproductive health-related claim, 39% were referred to Child Protective Services while 31% were referred to Juvenile Justice at some point during the study period. Reproductive health care was strongly associated with referral to Child Protective Services (adjusted odds ratio [aOR] 2.9, 95% confidence interval [CI] 2.5–3.4), substantiated sexual abuse (aOR 2.3, 95% CI 1.7–3.2), and referral to Juvenile Justice (aOR 2.9, 95% CI 2.5–3.4). These associations remained regardless of the type of reproductive health care, including contraceptive management.

CONCLUSION: Females aged 10–15 years enrolled in Medicaid who present for any type of reproductive health care are at increased risk of abuse by a caretaker and criminal behavior. Clinicians caring for low-income females should consider routine screening for sexual activity and the experience of violence.

LEVEL OF EVIDENCE: II-2






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Copyright © 2006 by the American College of Obstetricians and Gynecologists.