Behind the Numbers: Exploring the Social Drivers of Teen Birth Rates in the U.S.

Forty years ago, more than 50 out of every 1,000 teenagers aged 15 to 19 in the United States. gave birth. This was also when Sabrina Cabello, then a 16-year-old high school student from the Bronx, had her son. She had never received sex education, and she and her boyfriend at the time believed they were being careful by using the pull-out method.

At that time, students usually didn’t take the health class until the last semester before graduation, by which time many were already sexually active. In Sabrina’s eyes, the class wasn’t effective in helping students prevent pregnancy, particularly with projects like the egg assignment.

To pass class, Sabrina carried a boiled egg around for a week, pretending it was her baby. She needed to ensure her egg wasn’t cold or broken, so she put it in the refrigerator to keep it safe. Otherwise, her real baby might squeeze and break the egg, causing Sabrina to risk failing the class.

“This is not a simulation of what parenting is like. An egg doesn’t cry, doesn’t need diaper changes, and there are no daycare costs,” said Sabrina in a recent interview. “This is not realistically helping anybody avoid pregnancy.”

Since the 1980s, teen births increased until peaking in 1991, when more than 60 out of every 1,000 teenagers had babies. Since then, the number has steadily declined, and now there are only 13.2 births per 1,000 female teenagers, marking a decrease of 78 percent.

The significant improvement in reducing teen births is closely linked to the rise in education levels and increased access to resources and opportunities for females. In the 1980s, only about two-thirds of teenage girls graduated from high school. By 2022, this figure had risen to around 92 percent.

Since more teens' parents have graduated from high school in the past decades, teens are likely to follow suit and pursue higher education, said Dr. Claire Brindis, a Distinguished Emerita Professor of Pediatrics and Health Policy at the University of California, San Francisco. This trend provides them with more options and opportunities.

Dr. Brindis noted that for today's female teens, having a baby is no longer the only way to feel positive about their identities, and teenagers realize that having a baby will hinder their promising future when they see more career opportunities are available.

Although the country has generally experienced a great decline in teen births, there are still some states with high rates of teenage births. According to CDC’s 2022 birth data report, Mississippi topped the list, with over 26 out of every 1,000 teenagers being teen moms. The state was followed by Arkansas (25), Louisiana (24), Kentucky (22), and Oklahoma (21).

“These states are more conservative,” said Estelle Raboni, the director of Sexual and Reproductive Health at the Department of Health & Mental Hygiene in New York City. “Local cultural and religious beliefs about premarital sexual activity shape their public health policies.”

According to an analysis of 2022 teen birth rate data from CDC and 2020 presidential election results from CNN, nine of the top ten states with the highest teen birth rates had more Republican voters in the 2020 presidential election. John S. Santelli, a Professor of Population and Family Health and Pediatrics at Columbia University, pointed out the association between political affiliations and teen birth rates.

“Southern states and red states (states with more Republican voters) are generally more conservative toward sex and sex education, also more religiously conservative and less likely to get contraceptives, so teen pregnancy rates tend to be higher,” said Professor Santelli.

A data regression model using CDC teen birth rates data at the U.S. county level and the 2022 American Census Survey shows the availability of sex education really mattered to birth rates among teenagers. Counties that emphasize abstinence in sex education tend to have higher teen birth rates, meaning teenagers there are still having sex, and are more likely to give birth compared to teenagers in counties that have no requirement for abstinence education.

Among the 26 states with emphasis on abstinence, 18 were “red states” in the 2020 presidential election, according to an analysis of the data.

Dr. Keri Weed, a psychology professor from the University of South Carolina Aiken, noted that health care officials in these states are aware of the situation, but funding for sex education traditionally comes from national programs that must follow abstinence-only guidelines. These guidelines are often shaped more by the political authorities in power and their religious beliefs than by what is proven to work, though this may change with shifts in political leadership.

Beyond education and political factors, the data analysis shows that the poverty rate and related factors, such as health insurance coverage and median household income, significantly contribute to teen birth rates. Counties with higher teen poverty rates, lower insurance coverage, and lower median household incomes tend to have higher percentages of teen moms.

“In a county with a much lower poverty rate, pregnant teens have more available options, such as continuing their education, finding jobs, and making informed decisions about marriage and parenthood, which might lead them to consider abortion,” said Dr. Weed.

Dr. Weed also pointed out that these counties usually have higher median household incomes and insurance coverage rates, meaning more healthcare providers would be available there to offer more options for pregnant teenagers, including abortion and adoption services, as well as support for those who choose to keep their babies, and point them in the right direction.

The Big Picture: Decline in Teen Birth Rates

According to the CDC's birth rate report for 2022 and provisional data for 2023, the birth rate for females ages 15 to 19 in the United States has steadily declined, reaching 13.6 births per 1,000 in 2022, a two-percent drop from 2021.

Since 2009, the teen birth rate has consistently fallen, decreasing by 67 percent since 2007. In 2023, the birth rate dropped further to 13.2 births per 1,000, marking another record low.

Dr. Brindis believes the steady decline is due to efforts encouraging teenagers to graduate from high school and changes in young girls' perceptions of motherhood.

“More parents are graduating from high school, so their kids tend to graduate from high school. Some positive things are happening,” Dr. Brindis said.

The huge decline in childbearing in the country is affecting all age groups. Many women and young people are opting not to have children because they're worried about financial burden and environmental issues, Dr. Brindis added.

When looking at the teen birth rates by age group, we find the rate for teens aged 15 to 17 stayed steady at 5.6 births per 1,000 in both 2022 and 2023. For younger teens aged 10 to 14, the rate has remained unchanged at 0.2 births per 1,000 since 2015. For older teens aged 18 to 19, the rate dropped from 25.8 births per 1,000 in 2022 to a record low of 24.9 in 2023.

Dr. Weed discussed why the birth rates for younger teens have remained unchanged over the past eight years, even as rates for other age groups have declined.

“Younger teens face issues like unwanted sex, rape, and incest, and often feel too vulnerable to protect themselves,” Dr. Weed explained. “Many 12, 13, and 14-year-olds show curiosity and explore their sexuality, but sometimes find themselves in situations they can’t escape from and are reluctant to speak up due to fear or threats.”

She also noted that in more conservative areas where abortion is nearly banned, young teens who become pregnant are often unable to terminate their pregnancies, making their situation even more challenging.

Dr. Brindis explained that the unchanged rate for younger teens is due to the already low starting point, leaving less room for further decline. Unlike older teens, who generally have higher birth rates, the younger group’s rates are closer to a ceiling. To see further reductions in younger teens, there would need to be targeted support for those who are marginalized and have limited options, as these individuals are more likely to have fewer resources and alternatives besides keeping a baby.

The huge drop in teen birth rates had also to do with social media and pop culture. “Since the 1990s, there have been more movies and television shows telling young people not to have sex unless they have a condom,” said Dr. Weed. “Safe sex is valued in today’s pop culture.”

Poverty is the Driver of Every Problem. But HOPE is Everything.

Since 2000, New York City has seen an 80 percent decrease in pregnancy rates among teenagers ages 15 to 19. However, despite this significant progress, poverty remains a key factor in neighborhoods with high teen birth rates.

According to a 2021 vital statistics report released by the New York City Department of Health and Mental Hygiene, teen birth rates in very high-poverty neighborhoods (where 30 percent or more of the population lives below the Federal Poverty Line) were 14.1 births per 1,000 population, which is 4.2 times higher than in low-poverty neighborhoods (where less than 10 percent of the population lives below the Federal Poverty Line).

“Poverty tends to inform those communities. Poverty not only impacted teen pregnancy rates but also high unemployment rate, levels of incarceration or rates of diabetes or poor housing stock,” said Raboni.“Poverty drives everything, but underneath poverty is structural racism.”

She introduced that the neighborhoods that have been disinvested for decades in the city have been redlined and deeply segregated, with predominantly Black and Brown people living there. Parents in these disadvantaged neighborhoods may not have completed high school and are unable to secure high-paying jobs or health insurance that comes with those jobs, perpetuating these issues into the next generation.

Beyond intergenerational financial poverty, various forms of poverty, including a lack of hope, can make teen moms even more vulnerable.

“If a young person grows up believing they have many opportunities ahead and can achieve anything, they will hold on to that hope. That hope will drive them to access resources and opportunities, whether it's going to college or pursuing other goals, and they won't let anything stand in their way,” said Raboni. “Teenagers with hope are more likely to use birth control or delay becoming sexually active to stay on their chosen path.”

Dr. Brindis stressed that a sense of future and a sense of empowerment is crucial. Teenagers need to have the ability to move on with their lives and not be truncated by the fact that they live in a bad neighborhood.

The sense of hope is shaped by various social issues, including violence, alcohol and drugs. A study examining risk factors contributing to teen pregnancy found a history of child maltreatment significantly increases the risk of teen pregnancy among low-income adolescents, even when accounting for neighborhood disadvantages and other issues. Dr. Weed also pointed out that domestic violence in teens’ families can lead to unwanted sex, which is the major reason for pregnancies among girls under 15, as they are unable to protect themselves.

Gun violence and substance abuse are also markers of community stability for teenagers. “In violent communities, young people face the threat of being shot or imprisoned. They may have a child because they want someone to care for their families,” said Dr. Brindis. “Also, when teenagers are addicted to alcohol and drugs, they often lack money, which reflects the community’s hopelessness.”

Beyond the living environments, students' important sense of hope is also largely shaped by messages they receive in schools and from adults around them.

“Do they receive messages that they are smart and can succeed, or do they receive messages, particularly girls, that their currency, their value is based on how beautiful or attractive they are or whether or not they're able to have families, as opposed to that they're valuable because they're smart and they can go on to careers and things like that,” said Raboni.

However, Sabrina's experience was different. She was a straight-A student involved in cheerleading and drama club, and no one expected her to get pregnant at 16 in 1986.

Sabrina faced immense pressure when revealing her pregnancy. She had to explain her transfers between a maternity school and her original high school, and parents in her community used her as a cautionary example. Despite trying her best, her grades suffered as she juggled studying and caring for a baby. “That was definitely a self-esteem hit,” she said.

Unlike some Black teen moms, Sabrina faced high expectations to succeed academically, compounded by judgments about her pregnancy. Fortunately, her supportive mother helped raise her child and encouraged her to stay hopeful, enabling Sabrina to graduate from college.

“She said those people are making judgments and are not going to buy you diapers. They're not going to help you with milk. They're not going to take care of the baby. This is a gift from God and you're okay and we're going to do it together. So that gave me more strength to be, you know, stronger at the moment,” said Sabrina.

Blue vs. Red Counties: The Importance of Sex Education

Data analysis reveals that counties with higher percentages of Trump voters in the 2020 election also report higher teen birth rates. A study investigating conservative sex education policies supports this correlation, showing that states with more Republican voters are more likely to prioritize abstinence over contraception in their curricula. Both the study and the data regression model found that abstinence-based education fails to reduce teen birth rates.

Dr. Weed believes abstinence education does not resonate with young people and sets unrealistic expectations for them, which is not being sexually active until getting married.

“When teenagers enter relationships with this mindset, they are often unprepared when emotion takes over and don’t have contraceptives at hand when they want to have sex,” said Dr. Weed.

Dr. Weed highlighted that stressing abstinence would prevent teenagers from accessing the information they need. “Teenagers fear talking to their parents about getting or using condoms, and teachers here in South Carolina schools could be fired for providing sex-related information to students,” said Dr. Weed.

Regarding why “red counties” are being conservative toward teenagers’ sex, Dr. Brindis explained a “myth” there: adults feel like sex knowledge is dangerous—that knowledge puts ideas in young people's heads, and it causes young people to have sex, which Dr. Brindis believed is not true.

Raboni said that teenagers are actually equally sexually active in “red” and “blue” counties, no matter if adults block their access to information. In fact, she thinks that sex education helps young people delay having sex—with more information, teenagers tend to be more responsible about using contraceptives. Raboni strongly opposes abstinence education, believing it very disrespectful to human behavior and human development.

“It's like saying, I don't want you to get into a car accident, therefore never drive a car. And meanwhile, you live in a town where the only way for you to get around is to get in a car. And, you know, so eventually, you're going to have to be back in the car,” said Raboni. “People are going to be sexually active at some point.”

Dr. Weed explained that abstinence education in schools reflects the views of the school board, leaders, families, and the entire community. "It's not just that it happens in the classroom. It's saying that this is the culture of the whole community," she said.

In southern states like Mississippi and Louisiana, local officials are facing some of the nation's highest maternal mortality and morbidity rates. These regions often experience severe shortages of healthcare providers, known as "provider deserts," limiting access to essential care. In Mississippi, restrictive women's health policies have driven many OBGYNs out of the state, exacerbating the already critical shortage of healthcare services for women.

Midland County: High Income, High Teen Birth Rate

Data analysis shows that if a county has a higher median household income, it tends to have a lower teen birth rate. However, Midland County in Texas is an outlier here—despite having a median household income of $90,000, around middle-level compared to all U.S. counties, it experienced the fourth-highest teen birth rate.

Trey Lowe, a local non-profit executive director, explained the reason from demographic and geographic factors.

In Midland County, roughly 70% of students in the school districts are Hispanics. Many of them are first—or second-generation Americans. Since Midland County is a traditional oil and gas town, people can make significant profits without a degree.

Data from Data USA shows that in 2022, mining, quarrying, and oil & gas extraction was the largest industry in Midland County, employing nearly 1 in 5 people with a median annual income of $175,395. However, Midland County's educational attainment lags behind, with local universities awarding only 995 degrees that year, and just about one-third of the population holding a bachelor’s degree or higher—compared to nearly two-thirds in New York County (Manhattan).

“So there isn't the desire to push your child into something if you don't think it's needed,” said Lowe. “Many kids go straight into the workforce instead of college, and many 19-year-olds get married right out of high school, with someone earning $100,000 in the oil field.”

The difficulty of adhering to Christian values in the strongly religious Midland community also contributes to the high teen birth rate. Despite identifying as Christians, many teenagers still have sex.

“Christianity is popular to profess but not to practice,” said Lowe. “Many claim to believe in God and Jesus, but it's less common for high school students to strictly follow biblical teachings. They might identify as Christians because of belief or occasional church attendance, but their faith isn't typically devout.”

Despite Midland's high incomes, the cost of living offsets much of the wealth, with housing, food, and other essentials costing more than in other Texas counties, according to Lowe. He noted that Midland County operates in a financial bubble, where wages are inflated—even fast food chains like Whataburger pay $20 an hour with benefits, twice the rate seen elsewhere in Texas.

“There's so much oil money that the service industry here has to pay higher wages to keep employees, which then goes into the cost of the product,” Lowe explained.

Beyond the financial bubble, there is also the cultural norm of becoming a young mom after graduating from high school. Lowe’s mom had a daughter when she was 19 years old. He also started his family early and had a daughter when he was 18 years old.

“It is not socially acceptable to have a child in high school, but once you graduate, it is definitely acceptable to start a family,” said Lowe. “But girls from higher socio-economic families here are still expected to pursue higher education rather than start a family.”

In Texas, abortion has been banned since the Supreme Court overturned Roe vs. Wade in June 2022. In Midland County, where pro-life views dominate, some girls who wish to terminate their pregnancies drive 45 minutes to Mexico for abortion services.

“It is not something girls would be proud of to get pregnant here in high school. It's something they're ashamed of. So if they are having an abortion, they won’t let anyone know and move on with their life,” said Lowe.

Beyond driving to Mexico, pregnant teens can also use morning-after pills for a drug abortion, which remains legal in some areas of Texas. However, these pills are only effective if taken at the right time in the pregnancy cycle, and most young people don’t know how to do this without adult guidance.

“If you don't have doctors or professionals to tell you how to do the right thing, then younger people just gather abortion drugs and do it by themselves,” said Dr. Weed. “I feel like that will put them at risk.”

Sex Education Programs in New York City

In contrast to Midland County, New York City advocates for earlier sex education. Raboni noted that since 2011, the Department of Education has recommended public schools implement evidence-based sex education in sixth and ninth grades, and built various related programs to equip teenagers with the knowledge before they become sexually active to stay healthy.

With its developed system and effective education, New York City has seen an 80% decrease in pregnancy rates among teens aged 15 to 19 since 2000, which is 8% greater han the national decline in teen birth rates.

“I think the reason for the decline in birth rates is that young people are becoming sexually active later, when they have more critical thinking skills,” said Raboni. Dr. Brindis added that, on a national level, fewer teenagers are going on dates, which also contributes to delayed sexual activity.

But that doesn’t mean that young people have stopped becoming sexually active. She believes early sex education and accessible contraception had a primary impact in decreasing teen pregnancy rates over the past 20 years.

Looking ahead, Dr. Brindis emphasized the need to shift more people toward supporting early sex education and moving away from the belief that sex knowledge leads teens to have sex earlier.

“Engaging families in sex education is crucial since many parents lack sufficient sex education themselves and don’t have the skills to be effective educators,” said Dr. Brindis.