Overall teenage birthrates have fallen across the country, but women’s health care providers are concerned about the sharp disparities between white teenagers and teenagers of color.
The Centers for Disease Control and Prevention released a report Friday that found U.S. birthrates for women ages 15 to 19 declined in 38 states, 7% across the entire country in 2018. While white teenagers saw a significant decline in 29 states, Hispanic and Black teenagers saw a decline in only 10 states.
The report comes on the heels of a Supreme Court decision Wednesday that upheld a Trump administration regulation that allows employers with religious or moral objections to limit insurance coverage for contraceptives under the Affordable Care Act.
The decision means more than 100,000 women nationwide could lose their contraceptive coverage, including dependents under their parents’ insurance plan.
“My initial gut reaction is that it’s disappointing but not surprising unfortunately,” Dr. Melody Baldwin, assistant director of undergraduate medical education at Duke University’s Department of Obstetrics and Gynecology, said about the CDC report. “I think the same social determinants of all other health disparities are at work as with this particular disparity.”
Stacey Stewart, CEO of the March of Dimes, attributes the disparities to similar factors that caused COVID-19 to hit Black and Hispanic communities so hard.
"Black and brown adults aren’t treated equitably throughout our institutions, we can’t expect their children to be," Stewart said.
Some of the myriad factors that contribute to the disparities in teen birthrates include state policies and politics, limited access to birth control among communities of color and mistrust of the health care system due to the country's history of abuse and bias, according to women's health experts.
The only state that saw a significant increase in teen birthrates is South Carolina, particularly among Black women.
Dr. Paul Browne, medical director of Maternal-Fetal Medicine at Lexington Medical Center in South Carolina, said strict laws surrounding sex education and abortion, as well as other state specific policies regarding Medicaid, make it harder to prevent teen pregnancy and birth.
“I’m very disappointed our state isn’t doing better,” he said. “Preventing teen pregnancy empowers women to do better.”
Browne noted access to women's health services is particularly difficult in South Carolina as much of the rural state lacks public transportation. Many public services require more than one trip to complete, such as applying for Medicaid or terminating a pregnancy.
Baldwin said rural states sometimes lack doctors who specialize in fields that could affect teen birthrates. Though primary care doctors can easily prescribe birth control pills, some aren't trained or equipped to place long-acting reversible contraceptives, such as IUDs.
Studies show fewer than 1% of such users become pregnant, which contributed to the decline in teen pregnancy rates, Baldwin said.
"For younger girls, they don’t have to remember a pill every day," she said. "If they don't remember their homework, how are they going to remember this?"
Baldwin said the country has a history of forced sterilization, coercing IUDs and other implants on women of color, which led to mistrust of the health system.
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Dr. Rahul Gupta, chief medical officer at the March of Dimes and former health commissioner of West Virginia, said Black women are less likely to use contraception because of this mistrust.
Unfortunately, when studies are done, the response is often "let’s just do more education," and all the “perceived racism and bias in the system isn’t considered," he said.
"Addressing these disparities by increasing access to resources and sexual education, eliminating cost barriers to contraception, as well as tackling the systems that undervalue women of color, has the potential to significantly reduce disparities in teen pregnancy," Stewart said.
The CDC report offered some positive findings. A handful of states shared a victory in significantly decreasing birthrates among Hispanic and Black teens: Washington, Arizona, Illinois, North Carolina, Florida and California.
Gupta noted births to Black and Hispanic teen mothers was a “very high number to start with” and was dropping about 8% a year.
In West Virginia, Gupta said, generational messages began to change when women realized they missed educational opportunities because they gave birth so young.
“They didn’t want it to happen to their daughters,” Gupta said.
A Kentucky program that tried to discourage teen mothers from having second babies led to nearly all going to college and graduating, he said.
"Once they understand the economic opportunities, it’s the game changer. Young women who escape poverty become excellent role models,” Gupta said. “Peer pressure is a good thing.”
Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competition in Healthcare. The Masimo Foundation does not provide editorial input.
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This article originally appeared on USA TODAY: CDC: Teen birthrates decline, Black and Hispanic rates still behind