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Teen birth rates just hit an all-time low

Obamacare repeal could change that.

The teen birth rate hit a new low in 2016, falling 9 percent over the course of the past year, and 51 percent over the past decade. The data, reported Friday by the Center for Disease Control, reveals a huge public health victory — but one that actions by the Trump administration could threaten.

According to a new study from the CDC and NCHS released on Friday, the provisional teen birth rate in the US in 2016 fell 9 percent from 2015 — hitting a record low for the age group of women from 15 to 19. The startlingly sharp decline in teen births is great news because teen mothers are statistically more likely to drop out of school, fall below the poverty line, and miss opportunities to advance in the workplace. Researchers found that in 2016, the provisional birth rate for teenagers was 20.3 births per 1,000 women ages 15 to 19, down from a rate of 22.3 births per 1,000.

The new data is reflective of a longer-term trend, but it’s one that has been helped along by actions the Obama administration took to increase access to and overall affordability of contraceptives. And anything that was at the discretion of the Obama administration to enact is essentially at the discretion of the Trump administration to reverse.

Currently, the Trump administration is pursuing or supporting legislation to weaken the birth control mandate in the Affordable Care Act, eliminate a teen pregnancy prevention program, and cut Medicaid funding to women’s health service providers like Planned Parenthood that offer abortion, among their other services.

These results surprised even researchers who have watched teen birth rates drop for years

According to the report, the birth rates for teenagers ages 15 to 19 has declined by 51 percent since 2007 and 67 percent since 1991. But recent years have seen a particularly dramatic decrease.

NHCS, Division of Vital Statistics

In addition to the overall 9 percent decrease, the drop in birth rate for teens ages 15 to 17 was particularly sharp: down by 11 percent, from 9.9 births per 1,000 women to 8.8 births. (The rate for ages 18 to 19 was down 8 percent from 40.7 per 1,000 women to 37.5 per 1,000.)

To get these numbers for 2016, the researchers at the NCHS collected birth certificates for the 2016 year — which list information about the mother’s and father’s age, race, and residence, among other statistics — and represent 99.96 percent of all births in the country as of February 16, 2017.

Brady Hamilton, one of the study’s lead authors, described the drop in teen births as “drastic” and something “really quite astounding to see."

Because the data is based off of birth records alone, there's no information in the NCHS study about outside factors influencing these stats. But the physicians and advocacy groups I spoke with say the reason for this sharp decline is two-fold: easier access to contraceptives and teens using contraceptives if they believe their friends are.

Easy access to contraceptives keeps birth rates down

Elise Berlan, the lead physician of the Young Women’s Contraceptive Services Program at the Nationwide Children’s Hospital, described the role that widespread access to contraceptives played in this decline.

“It's very reasonable to think that if teen girls, and all women, really, don't have access to contraceptive care through their insurance then they are going to have more unintended pregnancies,” Berlan says.

Indeed, she says current uncertainty about how much, if any, of the Affordable Care Act will remain in place has those who provide medical care to children and teens concerned. The Affordable Care Act’s birth control mandate required health insurance plans to cover all 18 types of FDA-approved contraceptives without charging the patient a copayment or coinsurance even if they haven’t met their deductible.

“Specifically the Medicaid expansion and keeping young people on their parents' insurance has really been important for young people to access contraception,” says Berlan.

It’s worth noting that Obama also set aside $105 million to support community efforts to reduce teen pregnancy through a designated Teen Pregnancy Prevention Program (TPPP) and $7 million via the Public Health Service Act for the evaluation of teen pregnancy prevention activities as part of his FY 2015 Budget. (According to a press release from the Sexuality Information and Education Council, continued funding for the TPPP was secured through September 2017.)

Teens being susceptible to peer pressure helped, too

Bill Albert, chief program officer of the National Campaign to Prevent Teen and Unplanned Pregnancy, says another huge factor in the declining teen birth rate is peer influence — and contraceptive access and use factor in here, too.

“We know from research that teens who think their friends and peers are having sex are more likely to have sex themselves.” Albert says, “Similarly, if they think their friends are using contraception, they're more likely to use it themselves.”

“What we're seeing here,” he continues, referring to the new NCHS data, which shows teen birth rate falling from 1991 to 2016, “is two plus decades of steady declines and we should not be surprised at all that peer influence has had an effect.”

New Trump administration policy proposals could threaten this trend

Many of the Obama administration’s actions to push for better contraceptive access could be reversed by the Trump administration. Trump’s fiscal year 18 budget proposed eliminating the Teen Pregnancy Prevention Program completely, and the both the House proposed healthcare bill (AHCA) and the Senate proposed health care bill (BCRA) would slash Medicaid funding to women’s health providers like Planned Parenthood.

The downward trajectory in teen pregnancy is a long-term trend, but is nevertheless completely reversible, says Berlan. Cutting funding for health service providers like Planned Parenthood could reduce teens’ access to contraceptives both by making the costs for IUDs and other long-term contraceptives prohibitively expensive (an IUD can cost as much as $1,000) and making them harder to find — and also by limiting options for those who can't use a birth control pill or condoms for health reasons.

As it stands, the contraceptive mandate in Obamacare survives in the House and Senate proposed health care bills. This is because lawmakers can’t eliminate the requirement in a bill that receives a simple majority vote because of reconciliation rules. However, the Trump administration is working on an interim final rule that would undermine it by expanding the exemption for employers based religious objection.

Currently, under the ACA, most American businesses cannot seek exemption unless they fall into one of three categories: houses of worship, “closely held” private companies, and institutions with a faith-based mission. The Trump administration’s proposed new rule, now under review by the Office of Management and Budget, would reportedly allow any employer — not just the ones in the ACA’s three categories — to seek a moral or religious exemption from the mandate.

Mark Rienzi, senior counsel with Becket law firm, which advocates for religious liberty, says the argument against the birth control requirement is not aimed at restricting access to contraceptives, but rather at eliminating the ACA mandate. His firm represented the Little Sisters of the Poor — a nearly 200-year-old religious order with 2,300 members in the US — that fought the requirement at the Supreme Court level.

“What goes against religious liberty is unnecessarily forcing people to be involved who don’t want to be involved,” Rienzi said. “The fact of the matter is these drugs are widely available without dragging the nuns into it.”

But advocates on the other side of the argument, like Bill Albert, are afraid that removing the mandate will be an invitation for employers to stop providing insurance for contraceptives to save costs — and that it would ultimately impact women's ability to control when they get pregnant, including teenagers on their parents’ health insurance plans.

“If we limit access to contraceptives, we are going to have more unintended pregnancy in this country,” Albert says. “That's just like night follows day. I don't think that's a controversial statement or an out-on-the-edge statement — it's just a fact."