Recently, the Centers for Disease Control and Prevention published its most recent estimates of live births in the U.S. It showed that birth rates continue to decline nationwide, and teen birth rates specifically are at record lows. These findings have drawn widespread media attention and will certainly fuel the pronatalist movement’s concern that fewer people are getting married and having children. In fact, a senior medical analyst for Fox News explicitly described low teen birth rates as “the problem” driving overall fertility declines. He is not alone in this belief.
As a public health behavioral scientist who has spent my career researching adolescent access to sexual and reproductive health care, I felt a startling sense of whiplash upon hearing these panicked reactions. When I was at the CDC in the 2010s, during the “teen pregnancy prevention” era, these same data reports documenting declining teen birth rates were cause for celebration.
While it is shocking to now see declining birth rates framed as a concern, we should not be surprised. Both narratives — that teen birth rates are too high or too low — problematize teen pregnancy and childbearing. This negative framing stems from a desire to control adolescent sexuality and reproduction, typically for political or economic reasons or in service of conservative social goals related to marriage and family.
The history of the modern teen pregnancy prevention era demonstrates this fraught public discourse. In Bill Clinton’s 1995 State of the Union address, he decried the “epidemic of teen pregnancy and births where there is no marriage” as “the most serious social problem.” Moral panic about high teen birth rates was so widespread that the resulting campaign against teen pregnancy was a widely lauded, bipartisan goal. In 2008, when U.S. teen birth rates increased slightly, Fox News, the same outlet where people now characterize low teen birth rates as a problem, described the increase as “cause for concern.” From 2010-2016, teen pregnancy was deemed one of seven CDC “Winnable Battles” alongside severe, life-threatening health issues, like smoking.
While expanded contraceptive access resulting from teen pregnancy prevention initiatives has been critical to giving young people more control over their reproductive lives, we have also seen harms from the underlying premise that teen births should be controlled. Teen parents have been shamed and stigmatized. Paternalistic tactics, such as overemphasizing IUDs and implants, undermined young people’s reproductive health preferences and goals. The focus on preventing pregnancy as the sole way to lower teen birth rates has also negated abortion as an acceptable strategy to control one’s own fertility.
Now, the harmful consequences of the narrative that low teen birth rates are a problem are already underway. In an effort to restrict access to mifepristone, a drug used for medication abortion, a lawsuit filed by the attorneys general of Missouri, Kansas, and Idaho cited the population loss due to reductions in teen births associated with abortion as resulting in “diminishment of political representation and loss of federal funds.”
Adolescent access to contraception is also under attack, including the rollback of minor rights to consent to care and active disinformation campaigns that conflate abortion and contraception. Public narratives that frame low teen birth rates as a problem will only intensify these insidious efforts by introducing new people to pronatalist beliefs and fostering support for efforts that undermine contraceptive access.
Controlling teen fertility should not be a public health and policy goal. Reproduction is an inherently personal choice, and all people should be able to decide on their own terms whether and when to have children, as reproductive justice leaders have long said. The reality is that when young people have the information and resources they need to make decisions about their reproductive health, most will choose to delay childbearing. National estimates from 2015 found that more than half (53%) of teens who became pregnant said it happened “too soon,” and another 23% did not want to have a baby at all. The choice should be theirs, not politicians or pundits. Public policy should focus on creating systems that support both preventing childbearing and parenting, if that is what is desired. The lack of such systems of support is the real problem.
What would it look like to create a society that gives young people the information and resources needed to support all options? Comprehensive sex education, access to the full range of contraceptive methods and abortion care (meaning these services are widely available, at no cost, and without parental consent requirements), more economic opportunity, reduced childcare costs, and affordable higher education, to name a few.
All of this and more needs to be in place to ensure that all people, including teens, can make informed, autonomous reproductive decisions. That’s the battle we should be fighting to win.
Riley J. Steiner is a research associate professor and the director of research translation at CONVERGE at University of Pittsburgh.
