Nada Hassanein, Stateline
Houston OB-GYN Dr. Hillary Boswell says she has seen how abortion bans affect teenage girls: More of them are carrying their pregnancies to term.
“These are vulnerable girls, and it’s just heartbreaking to see the number of pregnant 13-year-olds I’ve had to take care of,” Boswell said, referring to the change since Texas prohibited abortions after six weeks in September 2021. In June 2022, after the U.S. Supreme Court overturned Roe v. Wade, Texas enacted a total abortion ban.
“They would come in, and they would be very distressed,” said Boswell, who spent the past decade treating underserved women and girls at community health clinics. Not being able to help them get an abortion when they wanted one, she said, “was so hard — and so against everything that I trained for.”
In the year after Texas began implementing its six-week abortion ban, teen fertility rates in the state rose for the first time in 15 years, according to a study released earlier this year by the University of Houston.
Overall, the increase in teen fertility in Texas was slight: only 0.39%. But the University of Houston researchers said the change was significant, because it reversed a 15-year trend and because the national teen fertility rate declined during the same period. They also noted that the increases were larger for Hispanic teens (1.2%) and Black teens (0.5%), while the rate for white teens declined by 0.5%.
So far, the Texas data is the first evidence that abortion bans might lead to an increase in teen births. But as abortion restrictions have spread post-Roe — 13 states now have total bans — some providers and other experts predict that other states will see increases. If so, the nation’s nearly 30-year trend of declining teen births could be in jeopardy.
Boswell and other providers note that teens are having a harder time accessing contraception and abortions — and they fear the incoming Trump administration could make it even more challenging for teens, whose pregnancies are riskier and who disproportionately sought abortions before the Supreme Court overturned Roe.
“In a lot of ways, Texas is sort of a microcosm of what we’re going to see in other parts of the country,” said Dr. Bianca Allison, a pediatrician and assistant professor at the University of North Carolina School of Medicine. “Historically, it has always felt like young people — those who are minors but of reproductive potential — are left out of the conversation of reproductive autonomy and rights.”
Access to pills
People seeking abortions have been relying on the broader availability of telehealth for medication abortions, which now account for nearly two-thirds of all abortions. The number of abortions in the U.S. has increased since the fall of Roe, largely because more people are using the easier-to-access method, according to the Society of Family Planning.
But the Trump administration could make it harder to procure the pills by reversing a current U.S. Food and Drug Administration policy that allows them to be sent through the mail. Some anti-abortion groups want the Trump administration to enforce the Comstock Act, a long-dormant 1873 law they believe could be used to make it a federal crime to send or receive abortion medication.
States also could require in-person physician visits for abortion medication, effectively barring patients from accessing it via telemedicine.
And Louisiana last month began classifying mifepristone and misoprostol — the two medications used in nonsurgical abortions — as controlled substances, making it a crime to possess them without a prescription. A Texas state lawmaker has proposed similar legislation in his state.
“I would absolutely predict that we will see a reversal in our progress of reducing teen pregnancies,” said developmental psychologist Julie Maslowsky, an associate professor at the University of Michigan who studies adolescent reproductive and sexual health.
“If someone does not want to be pregnant, they should have all the options available to them to prevent pregnancy,” Maslowsky said. “And the majority of teens do not desire a pregnancy.”
Teenage girls tend to have less money, less access to transportation and less independence than adult women. That makes it harder for them to cross state lines for abortion care, or to obtain and pay for abortion medication. A medication abortion can cost as much as $800, according to Planned Parenthood.
Many teens have trouble ordering abortion medication online because they don’t have credit or debit cards or a safe place where the pills can be mailed, said Rosann Mariappuram, senior reproductive rights policy counsel at the State Innovation Exchange, a nonprofit that advocates for progressive policies. Abortion funds that help people who can’t afford the care have been struggling to keep up with demand.
Thirty-six states require parental consent or notification before a minor can get an abortion, creating another barrier. And teens are more likely to have irregular menstrual cycles, which makes them less likely to notice a missed period. Overall, about a fourth of women might not realize they’re pregnant at six weeks, which is the gestational time limit for abortions in Florida, Georgia, Iowa and South Carolina.
In addition, a law in Texas that went into effect in April mandates that family planning clinics get parental consent for minors seeking birth control. Lawmakers in Oklahoma and Indiana have argued that IUDs and emergency contraceptives are types of abortions, and thus should not be covered by insurance or shouldn’t be available, said Mariappuram.
“That conflation of contraceptives with abortion care is just evidence that they’re coming for contraception,” she said.
Health risks, diminished prospects
Teenage girls from disadvantaged backgrounds are more likely to become pregnant. There have been persistent racial disparities in the national teen birth rate, with rates at least twice as high among Black, Hispanic and Native American girls. And while the average age of a girl’s first menstrual period has been declining for all girls, the trend is particularly pronounced among racial minorities.
“These downstream impacts [of abortion restrictions] are not the same for everyone,” said Mayra Pineda-Torres, an assistant professor of economics at Georgia Tech who specializes in gender and inequality. “The reality is that, still, there is a racial component here that may be exacerbating racial inequalities or this inability to access abortion services.”
Teenage motherhood often derails a girl’s education and diminishes her long-term financial prospects. And pregnancy poses particular health risks for teens: They are more likely to experience serious complications, including blood pressure-related disorders such as preeclampsia, and their babies are more likely to be born underweight. For those reasons, the American Academy of Pediatrics says teens should have access to legal abortion care.
But to abortion opponents, teen pregnancies and births are preferable to teen abortions. Joe Pojman, founder and executive director of the Texas Alliance for Life, said the state has programs designed to help families, including teen parents, take care of their children.
“[The program] teaches them a variety of things, like how to manage a budget, how to apply for a job, how to basically make that child self-sufficient to be able to function,” Pojman told Stateline.
“We don’t want to encourage a child to be responsible for taking the life of her own unborn child,” he said.
Last month, Missouri Attorney General Andrew Bailey filed a lawsuit with fellow Republican attorneys general in Kansas and Idaho that asked a Texas judge to order the FDA to reinstate restrictions on mifepristone. They argued that lower teen birth rates harmed their states by shrinking their population, costing them federal money and congressional representation.
But some studies suggest the opposite. The federal government cites research showing that teen pregnancy costs taxpayers about $11 billion per year because it leads to more public spending on health care, foster care, incarceration rates of teen parents’ children, and lower education and income.
“Pregnancy is not benign,” said Allison, the North Carolina pediatrician. “It’s not a joyful, welcome thing for a lot of people across the country.”