TThe risk of teen pregnancy continues to rise at an alarming rate. That equates to 5% of all births in the United States in 2022, or more than 146,000 teen births—the vast majority of which are often unplanned. This is due in part to the advancement of our physical development. In May, In 2024, the Harvard TH Chan School of Public Health released important data showing the continuing trend of earlier puberty in girls. Combined with data showing that more than 30% of teens have sex (mostly without contraception), this sheds light on the importance of reproductive care and sex education for young people.
But in the post-roe, Dobbs In the era of abortion restriction, we see policies and laws that go beyond abortion restrictions and restrict sex education and access to contraception. We must therefore ask ourselves how DobbsPolicies of the era will address the biology and behaviors of puberty to reduce unwanted teen pregnancy.
Over the past few decades, the age at which girls get their first period, medically known as menarche, has gradually declined in the United States. It is thought that changes in weight or body fat may play a role in this phenomenon in children, but other factors, including environmental exposures, may also play a role. The average age for the first period is now just under 12 years old, when most girls are in fifth or sixth grade. For up to 15% of girls, the first menstrual cycle occurs by age 10, when most girls are just in fourth grade. The trend toward earlier puberty is even more pronounced among children of color, with menarche now occurring in black and Hispanic girls at around 11 years and six months.
Although the proportion of teens reporting sexual activity has declined slightly in recent years, data from the 2021 CDC Youth Risk Behavior Survey (YRBS) show that 30% of high school students have had sex and 20% are sexually active. Only 50% of these sexual encounters used condoms, and only 37% of sexually active women used hormonal contraception. Previous studies of middle school students found that 5% to 20% of sixth graders and 14% to 42% of eighth graders had had sexual intercourse. Unprotected sexual practices not only put children at risk for pregnancy, but also increase the risk of sexually transmitted diseases such as HIV, hepatitis C, syphilis, and gonorrhea, which are on the rise among young people.
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An estimated 61% of pregnant teens give birth, 25% have an abortion, and 15% of pregnancies end in miscarriage or stillbirth. Looking at legal abortions in the U.S. in 2021, 0.2% of abortions were performed on people under 15 and 9% were performed on people between 15 and 18. This year, of the nearly 650,000 abortions performed in the U.S., about 1,400 were performed on children under 15 and about 56,000 were performed on children between 15 and 18. In the coming years, we will likely see fewer teen abortions and more unplanned births, especially among those unable to travel from states that ban abortion. And as puberty begins earlier, this problem is expected to increasingly impact younger adolescents.
The value of improving the availability of contraception for teens is demonstrated by the fact that the teen birth rate has fallen nearly threefold over the past two decades. The teen birth rate was 61.8 per 100,000 in 1990 and 13.4 per 100,000 in 2022. But across racial and ethnic groups, the birth rate for black and Hispanic girls is now almost twice as high as for white girls. It is about 20.3 per 100,000 for black and Hispanic girls and 9.1 per 100,000 for white girls in 2022. This difference reflects, among other things, the different access to contraception.
Preventing teen pregnancy rests on two essential pillars: education and availability of contraceptives. A large body of evidence shows that teenage contraceptive use—including IUDs, long-acting contraceptives (LARCs), oral contraceptives, and condoms—has an excellent safety and effectiveness profile when used correctly. However, access to contraceptives among teens varies by state. In 27 states and the District of Columbia, teens can obtain medical contraceptives without parental or guardian consent. In other states, minors can consent to contraceptives without parental consent, but under special conditions. When parental consent is required for teenage contraception, use of sexual health services is reduced.
However, last year saw a major milestone in access to contraception. In July 2023, the FDA approved the first over-the-counter oral contraceptive, Opill, which is available at low cost and with no age restrictions. Emergency contraception, including Plan B, is also available over the counter and with no age restrictions. Again, there are issues with availability, as some pharmacists have denied emergency contraception and birth control to pregnant teens because of their beliefs.
The second pillar of teen pregnancy prevention is sex education. It is recommended to consider the age at which children enter puberty and start sex education in third or fourth grade. There are also well-developed and effective school sex education programs that include pregnancy prevention training. These programs also address the prevention of sexually transmitted diseases.
The problem is that not only do these programs vary from state to state, but many reproductive health programs also begin after children have reached puberty and are not comprehensive. Many of the same states that restrict access to abortion are now also restricting sex education classes in schools, in part to avoid discussions about the LGBTQIA+ community. Some of these changes are being promulgated under the guise of “parental rights” or “promoting abstinence.” While promoting abstinence may reach some students, in most cases it is not a practical strategy for preventing teen pregnancy. Many parents also feel uncomfortable talking to their children about sex and do not have the background to educate their children at the level that medical professionals can provide, nor can they adequately talk about different contraceptive options.
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There are other potential legal consequences of teen pregnancy that we are seeing with the criminalization of assisting teen abortion. Many people living in states with abortion bans travel to other states or use telemedicine for abortion services. Yet two states, Idaho and Tennessee, will now prosecute adults who assist minors in obtaining abortions. We have seen similar state-sanctioned anti-parental actions against those seeking mutually acceptable, gender-affirming care for their children. This shows how some states are legally overriding parental rights in matters traditionally handled between family and doctor.
Following the Dobbs decision, we heard that some states restricting abortion would provide additional support to pregnant women and families of unintended pregnancies. However, it is unclear whether additional services were provided. In states with restrictive abortion laws, the number of children placed in foster care has also increased, but women and children have also historically been offered fewer supports. These facts, combined with higher rates of pregnancy among black teens, have led to the belief that abortion bans in states with large black populations will exacerbate racial inequities in child welfare systems.
No matter where we live, we need to recognize the biological changes our children are experiencing and create safe spaces where they can learn – and thus prevent unwanted pregnancies. It is not possible to eliminate these biological facts through legislation, by restricting sex education or by changing the availability of contraception for teenagers. Instead, we need to recognize the importance of this issue, especially in the postpartum period.roe era instead of falling back.
