Students wait for a bus outside Lane Tech College Prep High School in Chicago. Teen birth rates have been falling for decades, but abortion bans threaten to undo that progress, experts say. (Scott Olson/Getty Images)

Houston OB-GYN Dr. Hillary Boswell says she has seen how abortion bans affect teenage girls: More of them are carrying their pregnancies to term.

“These are vulnerable girls, and it’s just heartbreaking to see the number of pregnant 13-year-olds I’ve had to take care of,” Boswell said, referring to the change since Texas prohibited abortions after six weeks in September 2021. In June 2022, after the U.S. Supreme Court overturned Roe v. Wade, Texas enacted a total abortion ban.

“They would come in, and they would be very distressed,” said Boswell, who spent the past decade treating underserved women and girls at community health clinics. Not being able to help them get an abortion when they wanted one, she said, “was so hard — and so against everything that I trained for.”

In the year after Texas began implementing its six-week abortion ban, teen fertility rates in the state rose for the first time in 15 years, according to a study released earlier this year by the University of Houston.

Overall, the increase in teen fertility in Texas was slight: only 0.39%. But the University of Houston researchers said the change was significant, because it reversed a 15-year trend and because the national teen fertility rate declined during the same period. They also noted that the increases were larger for Hispanic teens (1.2%) and Black teens (0.5%), while the rate for white teens declined by 0.5%.

So far, the Texas data is the first evidence that abortion bans might lead to an increase in teen births. But as abortion restrictions have spread post-Roe — 13 states now have total bans — some providers and other experts predict that other states will see increases. If so, the nation’s nearly 30-year trend of declining teen births could be in jeopardy.

Boswell and other providers note that teens are having a harder time accessing contraception and abortions — and they fear the incoming Trump administration could make it even more challenging for teens, whose pregnancies are riskier and who disproportionately sought abortions before the Supreme Court overturned Roe.

“In a lot of ways, Texas is sort of a microcosm of what we’re going to see in other parts of the country,” said Dr. Bianca Allison, a pediatrician and assistant professor at the University of North Carolina School of Medicine. “Historically, it has always felt like young people — those who are minors but of reproductive potential — are left out of the conversation of reproductive autonomy and rights.”

Access to pills

People seeking abortions have been relying on the broader availability of telehealth for medication abortions, which now account for nearly two-thirds of all abortions. The number of abortions in the U.S. has increased since the fall of Roe, largely because more people are using the easier-to-access method, according to the Society of Family Planning.

But the Trump administration could make it harder to procure the pills by reversing a current U.S. Food and Drug Administration policy that allows them to be sent through the mail. Some anti-abortion groups want the Trump administration to enforce the Comstock Act, a long-dormant 1873 law they believe could be used to make it a federal crime to send or receive abortion medication.

States also could require in-person physician visits for abortion medication, effectively barring patients from accessing it via telemedicine.

And Louisiana last month began classifying mifepristone and misoprostol — the two medications used in nonsurgical abortions — as controlled substances, making it a crime to possess them without a prescription. A Texas state lawmaker has proposed similar legislation in his state.

“I would absolutely predict that we will see a reversal in our progress of reducing teen pregnancies,” said developmental psychologist Julie Maslowsky, an associate professor at the University of Michigan who studies adolescent reproductive and sexual health.

“If someone does not want to be pregnant, they should have all the options available to them to prevent pregnancy,” Maslowsky said. “And the majority of teens do not desire a pregnancy.”

Teenage girls tend to have less money, less access to transportation and less independence than adult women. That makes it harder for them to cross state lines for abortion care, or to obtain and pay for abortion medication. A medication abortion can cost as much as $800, according to Planned Parenthood.

Many teens have trouble ordering abortion medication online because they don’t have credit or debit cards or a safe place where the pills can be mailed, said Rosann Mariappuram, senior reproductive rights policy counsel at the State Innovation Exchange, a nonprofit that advocates for progressive policies. Abortion funds that help people who can’t afford the care have been struggling to keep up with demand.

Thirty-six states require parental consent or notification before a minor can get an abortion, creating another barrier. And teens are more likely to have irregular menstrual cycles, which makes them less likely to notice a missed period. Overall, about a fourth of women might not realize they’re pregnant at six weeks, which is the gestational time limit for abortions in Florida, Georgia, Iowa and South Carolina.

It's just heartbreaking to see the number of pregnant 13-year-olds I've had to take care of in the last three to four years.

– Dr. Hillary Boswell, Houston OB-GYN

In addition, a law in Texas that went into effect in April mandates that family planning clinics get parental consent for minors seeking birth control. Lawmakers in Oklahoma and Indiana have argued that IUDs and emergency contraceptives are...