teen pregnancy

The CDC reported last week that births increased by just 1 percent in 2024 with the fertility rate (TFR) remaining level at about 1.6, well below the 2.1 level needed to maintain the population level through births alone (i.e. without immigration).

At the same time, the Guttmacher Institute estimated that clinician-provided abortions in 2024 in states without a total abortion ban increased also by slightly less than 1 percent from 2023. There were additional abortions of an undetermined number that were not clinician provided.

The Trump Administration is considering ideas to increase the birth rate, among them a $5,000 baby bonus, tax credits for children, increasing the availability of IVF, and awarding medals to mothers of a certain number of children. Worldwide incentives of this sort have been largely money wasted. My October 16, 2024 post talks about Norway and Hungary’s futile efforts to increase their birthrates. At most, incentives have speeded up childbearing but not increased the number of desired children. Russia awards an Order of Parental Glory to parents of large families. It hasn’t stopped the decline in the Russian TFR. A similar award in France has had no effect either.

The Administration’s cutting of Title X funding for family planning and threatened cuts to Medicaid program (as well as criminalizing abortion if they seek a nationwide ban) will perhaps serve to increase unintended childbearing, especially among teens. The decrease in the national TFR has come because of a reduction in teen pregnancy over the years largely due to better and longer-lasting contraception. Teens and young adults are also reporting having less sex. Criminalizing abortion further and reducing access to contraception may serve as further deterrents to sex and hence pregnancy, but I suspect the pregnancy and childbearing rates will rise among those without access to private family planning services, i.e. the poor and minorities, exactly the groups that the conservative White Replacement Theory folks don’t want to reproduce.

The issues around infertility and IVF are tying the Administration in knots given the sway of absolutist anti-abortion people in policy circles. The imperatives of couples wanting a child by any means often outweigh their beliefs on abortion.

The causes of infertility in males and females are debated, but one thing is sure: sexually transmitted infections can cause infertility. And the Administration by cutting reproductive health care programs will be increasing STIs and hence infertility.

Who ever said politics makes sense.

A recent study out of Canada reports that women who were pregnant as a teenager were more likely to die before age 31 than their peers who did not get pregnant. The odds were similar for teens who had an ectopic pregnancy, miscarriage, stillbirth, or abortion. The risk increased the younger the teen was when pregnant and also if the teen was pregnant more than once.

The researchers say that the link between teen pregnancy and early death is likely not causal. The greatest cause of death was injury, both self-inflicted and accidental. How accidental death or suicide relates to early pregnancy is a murky area, but they could result from low educational attainment, adverse childhood experiences and increased risk taking.

Various experts opined that more needs to be done to prevent accidental pregnancy and unplanned pregnancy. I agree.

But I and others have felt that despite what teens may report about whether their pregnancy was “accidental”, many are in alignment with the shortened life expectancies that disadvantaged teens face whether or not they become a teen mother. This “weathering” hypothesis I have written about before. The many environmental, social, racial, familial, and pre-existing health factors that a disadvantaged teen faces all point to a life expectancy below that of her better off peers. The same applies to the teen’s mother who might be expected to help care for the baby. Weathering would seem to point a teen, consciously or not, to early childbearing while a) she is still relatively healthy and b) her mother is still with her to help. Researcher Arline Geronimus found that a disadvantaged teen is healthiest at age 16.

Risks of pregnancy are well known, and pregnancy is riskier the poorer the health of the mother. It is no surprise that it can lead to premature death, though as I said above, the researchers did not find a direct causal link.

But, and this is a big but, the teen has a baby. She has reproduced, and has done so when she is at her healthiest. Yes, there are risks to her and the baby, but perhaps less risks than if she had waited.

In an ideal world, women would not have to make this trade off. But even in countries with national health systems and with income supports for the most disadvantaged, the health discrepancies are still there. The messages of: wait until you are older, wait until you finish your education, wait until you have a good job, or wait until you are married, don’t resonate with all too many girls. The biological message of: reproduce while you can, does.

See:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816198

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816201