Teenage girls in rural America could be the first to see a rise in unplanned pregnancies as drastic cuts in access to health care, contraception and insurance take effect under President Donald Trump’s policies, say family planning campaigners.
Living in remote areas leaves those teens, already behind their urban and suburban peers in terms of income and education, most at risk, they say.
Teen pregnancy in the United States has been declining for decades, but experts fear abrupt funding cuts, including $213 million for the Obama-era Teen Pregnancy Prevention Program, will reverse the trend.
“When you take away funding that provides access to birth control for the most vulnerable people, they are going to have consequences,” said Katrina Main-Dorsky, a nurse practitioner for Maine Family Planning, which runs clinics in remote regions.
“The teen pregnancy rate will go up. I can’t say for sure when, but kids are not going to stop having sex,” she told the Thomson Reuters Foundation.
Currently at a record low, there are 22.3 births for every 1,000 girls aged 15 to 19, according to the U.S. Centers for Disease Control.
Rates are highest in the South, where many states mandate children be taught abstinence-only sex education in schools.
County maps show higher rates for rural teens, no matter what state they live in. In the nation’s most sparsely populated counties, 30.9 girls per 1,000 get pregnant.
“A lot of teenage pregnancy is because there aren’t many places to get free or cheap birth control here,” said Erica Swett, 19, who lives in Enfield, a small town in New Hampshire. She has one son and is about to give birth to her second child.
A clinic across state lines about 14 miles (22 km) away is out of reach for many teens, she said.
“You have to make an appointment for after-school hours and drive there. It’s really hard if people don’t want their parents to know or don’t have a car,” said Swett.
When she first learned she was pregnant at 16, Swett couldn’t drive. In any case, braving small-town health centers can be daunting, she said.
“People worry that just walking into the clinic means people will think they’re pregnant or that they have an STI (sexually transmitted infection),” said Yasmine Malone, 19, of Clarksdale, Mississippi, where schools teach abstinence-only sex education.
“It doesn’t stop people from having sex,” said Malone, now a healthcare activist and student. “It just encourages them to be ignorant and afraid of going to the doctor.”
If rural teens feel judged for seeking birth control, small-town negativity can intensify once they give birth.
Talazia Michelle Walther of Madison, West Virginia, got pregnant at age 14. Her mother looks after her child while the now 17-year-old goes to school and works five days a week at a fast-food restaurant.
She plans to go to college to study nursing.
“I’ve heard so many times, ‘You’re so young. You’ve thrown your life away,'” she said. “I hate that. It’s not true.”
For those who choose abortion, access can be difficult, or almost impossible.
Nekkita Beans, 21, who grew up in Philadelphia, a small town in the Mississippi Delta, knew 20 teens who got pregnant, including her older sister, by the time she finished high school.
Beans, a university student who volunteers for a teen health organization, said for her school friends to get an termination they would have needed to make a 160 mile (260 km) round trip to Mississippi’s lone abortion clinic.
“Protesters outside the clinic heckle, shout and tell patients they’re going to hell. Sometimes they videotape women as they go in, to make them feel more ashamed,” she told the Thomson Reuters Foundation.
Those who chose to raise a child face financial challenges.
Swett graduated from high school with good grades and took some college classes but works at a low-end retail store. Money is tight, and she relies on government benefits.
“If I work a lot, I don’t get to spend much time with my son. But if I work fewer hours, I don’t make enough to cover our bills,” she said.
America’s rate of teen pregnancy is high compared with countries with more accessible sexual and reproductive healthcare and sex education.
In Switzerland, the teen birth rate is eight young women per thousand, and in the Netherlands it is 14, reports the Guttmacher Institute, a research group focused on sexual and reproductive health.
In Maine, Main-Dorsky, the nurse practitioner, says more school clinics and birth control by mail would be effective.
The Centerstone Teen Pregnancy Prevention program in rural Tennessee, which has seen its funding cut under Trump, has found open, frank talks with teens about pregnancy has helped push rates down.
Based in the Nashville area, Centerstone has helped lower pregnancy rates by 30 percent in a six-year period by providing medically accurate sex education and encouraging parents to talk to their teens, said Ashleigh Hall, its outreach coordinator.
“We’re taking away the stigma of talking about sex,” said Hall, who said the group is disappointed about the funding cuts.
“The more conversations teens have, the better. They need ‘askable’ adults,” she told the Thomson Reuters Foundation.
If slashes in funding continue, she said, the group would be unable to do its work. “The communities we serve will no longer have this important education,” she said.