Dr. Bianca Allison: Teen births

[0:00:18]

BIANCA ALLISON: I am Bianca Allison. I’m an assistant professor of pediatrics at the UNC, University of North Carolina, School of Medicine. I am also a practicing primary care pediatrician and a health services researcher. My research and clinical interests are focused on the equitable and person centered provision of contraceptive counseling and pregnancy options counseling, particularly for adolescents and young adults.

[0:00:49]

BIANCA ALLISON: So, the teen birth rate in the United States has significantly decreased over the past few decades, dropping from a peak of about 62 births per 1000 adolescents in 1991 down to about 13 births per 1000 in 2023. And this is likely attributed to lower rates of teen pregnancy in the context of higher use of contraception and continued access of abortion. But we do know that Black and Hispanic teens have higher birth rates than their white peers, indicating likely ongoing disparities attributable to contraception access. And since the Dobbs v. Jackson Women’s Health Organization decision, we are still waiting to see birth rates from many states, so we don’t have robust and complete data to be able to determine this for most states in the U.S.

[0:01:44]

BIANCA ALLISON: We’ve recently learned that the teen birth rate in Texas increased slightly after Dobbs, which does reverse a long-term decline in birth rates in Texas. And while this coincided with their restrictive abortion laws, we can’t really say for certain that this was the cause. So, there’s many factors that can contribute to changes in birth rates, including other laws that restrict reproductive health care provision, and it’s also only one data point, so we’re really unable to say if this is truly a trend. And in terms of other states, Texas is likely a harbinger of what’s to come for other states with reproductive health policies, since it is one of the strictest legal environments that we have, and so we’ll have to wait and see what other states show in terms of their teen pregnancy and birth rates as well.

[0:02:37]

BIANCA ALLISON: We’re really waiting to see if, for the next two to three years, likely, what the teen birth rates and pregnancy rates will be after Dobbs, since organizations and researchers are analyzing these recent trends and their impacts. CDC WONDER has births by states through 2023 with some provisional data through the past month, but we really don’t yet have enough population-level information to know what the actual teen birth rates are. I’m also really unaware of recent data on teen pregnancies. So, in order to calculate teen pregnancy rates, we need not only teen birth rates, but also age specific abortion rates, which haven’t been collected post-Dobbs in a really robust way. This could be calculated for teens in a few states using some CDC abortion report data, but data quality really is a big issue at this point.

[0:03:40]

BIANCA ALLISON: Adolescents have always experienced higher barriers to reproductive health access, and that’s only worsened since Dobbs. So, for example, teens were unable to travel easily since they can’t rent cars, buy bus or plane tickets, reserve hotel rooms without a parent or adult involved. And abortion restrictions after Dobbs may have forced the closure of many local clinics and forced people to go across state lines to access abortion care, which can add additional barriers for teens. Also, laws like those in Idaho and Tennessee have made it a crime for adults to support a minor in obtaining an abortion, which adds unique post-Dobbs barriers for young people. We’ve also seen that options for telehealth provision of abortion, which are growing increasingly common and preferred, often do not allow access to care for minors or might only with parental consent. Lots of clinics that provide abortion and contraception have closed in restrictive states, including Title 10 clinics, which makes finding affordable clinics for abortion and contraception more complicated for young people.

[0:04:48]

BIANCA ALLISON: Before I respond to the question, I just want to say that the data that we have indicates associations between teen births and certain educational, professional outcomes, but one might not cause the other. And in fact, many of the outcomes around teen births are due to the lack of societal, institutional, and systemic support that teens receive to parent, not their lack of ability to parent. So, in terms of the associations that we do know, teen parents are less likely to finish high school, and those that do may face challenges in pursuing higher education. In early parenthood, maybe relatedly, can limit career opportunities and earning potential, which can perpetuate cycles of poverty and economic hardship for those teen parents as well as their children.

[0:05:36]

BIANCA ALLISON: In terms of the health risks, there are lots of different risks for people of all ages, including preeclampsia, hypertension, eclampsia, diabetes, miscarriage, preterm labor—there’s lots and lots of them—but for young people specifically, there are a few specific concerns that may stem from receiving inadequate or late prenatal care or just objectively be higher risk based on their age for both mother and baby. So, for example, during pregnancy, teens have a higher risk of preeclampsia, gestational hypertension, eclampsia, and anemia. They also have higher rates of STIs during pregnancy, including chlamydia and gonorrhea, which can increase their risk for things like miscarriage, preterm labor, and neonatal complications. In terms of birth outcomes, a lot of young people are at higher risk for having poor birth outcomes, including preterm birth, low birth weight, and small-for-gestational age infants and younger maternal age does correlate with increased risk of these outcomes.

[0:06:43]

BIANCA ALLISON: My research focuses on helping clinicians deliver equitable, person-centered contraceptive care and pregnancy options counseling for adolescents. So pregnancy options counseling meaning helping them decide what to do after a positive pregnancy test, like abortion, parenting, or making a plan for adoption. Any effort to reduce unintended pregnancies and births needs to focus and include increasing access to nonjudgmental and unbiased counseling in clinical settings. This allows teens to make the best decisions for themselves regarding their reproductive futures, and we know that this is a gold standard for many national medical organizations, but our research has found that a lot of clinicians don’t know how to do this well.

Our research in the past has also found that teens are not getting the quality of contraceptive care that they desire and that clinicians might recognize the importance of non judgmental, unbiased counseling for both contraception and pregnancy, but are often providing biased care, and that they are differentially discussing methods or excluding methods altogether when they discuss contraception and pregnancy with different populations. So, it’s really important for us to improve the clinical environment and the patient-centered clinical relationship in which young people are accessing reproductive health care. So, our research team now is focused on creating clinician-focused interventions to expand access to high-quality pregnancy options counseling and person-centered contraceptive care, which we hope will be especially impactful for communities that are disproportionately affected by restrictive reproductive health policies.