Reproductive health, criminal activity, and abuse among 10- to 15-year-old females enrolled in medicaid.

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.