Adolescent Medicaid Enrollees Seeking Reproductive Health Care More Likely to b

Adolescent Medicaid Enrollees Seeking Reproductive Health Services Have Increased Risk of Abuse and Criminal Activity 
 
Posted by: Jamie D. Brooks 
The Guttmacher Institute has posted an alarming report on adolescent, female, Medicaid enrollees. The report is based upon a study featured in Obstetrics and Gynecology entitled Reproductive health, criminal activity and abuse among 10- to 15-year-old females enrolled in Medicaid, written by BD Gessner. 
The researchers found that female Medicaid enrollees aged 10-15 who sought reproductive health services for pregnancy care, abortions or contraceptives had more than two times the chance of other Medicaid enrollees in the same age-group of being sexually abused by a caregiver. The research also showed that these young girls had an increased risk of physical abuse and being involved in the juvenile justice system. 
The study was instigated to explore the possibility of automatically screening young female patients seeking reproductive health services for abuse and exposure to violence. It took a cross-sectional analysis of the following Alaskan public health databases: a data file of all females who were enrolled in Medicaid at any point in 1999-2003 and who were 10-15 years old on December 31 of any study year; a database of all females in that age-group who were referred to the state?s child caregiver in 1999-20003; a similar database for referrals to the state?s juvenile justice system; and a database of births to Alaskan residents. 
The analyses of the data showed that young women with reproductive health claims were more likely than other Medicaid enrollees to be referred for any reason to child protective services (odds ratio, 2.9) or to have experienced physical or sexual abuse (1.6 and 2.3, respectively). Young women who?d had an abortion had higher odds of physical abuse (2.3). And young women who received pregnancy care had very high odds of sexual abuse (3.2). Young women with reproductive health claims were also more likely than other Medicaid enrollees to be referred to the juvenile justice system for a criminal offense (odds ratio, 2.9), violent offenses (3.1), or theft (2.4). This seems to indicate that providers of reproductive health services should be alerted to the fact that young girls may need additional assistance beyond that of just reproductive health care. 
The study notes that these findings may not be applicable to preadolescents and adolescents not enrolled in Medicaid, or outside of Alaska as poverty and/or location may also be a factor increasing a young woman?s risk of abuse, criminal activity and early sexual initiation. However, the article does conclude that, ?clinicians providing care to this population should consider routine screening for sexual activity and experience of violence and should adhere to mandatory reporting laws when child maltreatment is suspected or identified.? The Guttmacher article is available at http://www.guttmacher.org/pubs/journals/3822706/html and the study can be found in Obstetrics & Gynecology, 2006, 108(1); 111-118.2. Errata, Obstetrics & Gynecology, 2006, 108(4):1035. 
For other articles and resources on Medicaid and women?s health issues please see the National Health Law Program?s website at www.healthlaw.org
 

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