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Fear of pregnancy: One teen's story in post-Roe America

Juliet was hanging out with her aunt and relaxing, floating in a lake in Georgia last spring when her aunt brought up birth control.

Juliet is 15, in ninth grade, and she's got a lot going on. She's learning to drive, plays tennis, is serious about flute in marching band, and she's taking two AP classes. She's also totally indifferent to dating and having sex. "I just don't think it's interesting," she says.

The conversation with her aunt made her realize there were "a bunch of different types of birth control that I didn't know existed," Juliet says. (NPR is only using her first name to protect her privacy as a minor talking about her sexual health.)

She'd had sex ed in school – in Georgia, it's not required to be comprehensive, and must emphasize abstinence before marriage. She says she didn't learn much about birth control options beyond the pill.

Then, in late June 2022, a few weeks after that conversation with her aunt, Roe v. Wade was overturned by the Supreme Court. Georgia passed a trigger law in 2019, which is now in effect and bans abortion after six weeks, before many people learn they are pregnant. There is an exception for rape, but only with a police report.

Because of the new law, Juliet and her mom started talking about birth control. Her mom thought Juliet could pass the information along to her friends who were sexually active. "It didn't occur to me that she was asking for herself at all," her mom says. But she noticed her daughter seemed anxious and stressed, and soon Juliet told her mom she wanted to start on birth control, too.

"I don't think that it was ever expected that I would want birth control," Juliet explains. "I just didn't want to have to be so worried about – if I ever did get raped, which I hope it doesn't happen, but if it ever does happen and I wasn't on birth control, there would be a chance that I would have to keep the baby."

"I feel, after everything happened," she explains – with Roe v. Wade overturned and the six-week ban taking effect – "I just wanted to be a little in control."

Just one more stressor

Juliet was expecting her mom to say no to birth control. "We've talked about it before and it seemed like she was pretty against that because it can mess up your hormones," she says. "I don't think someone as young as me would usually be the norm to be on it."

It's true that her mom was hesitant. "It's not something I like," she says. "[Juliet] experienced COVID all middle school – it hit at the end of sixth grade. She had some really, really rough depressive patches, and I just – I was scared to death of what [birth control] could do to her emotionally."

Still, she could tell Juliet was really thrown by the Supreme Court decision and the sudden loss of access to abortion in her home state.

"You seemed so anxious," she says to her daughter. "You just felt like you couldn't control your own life – and that was so upsetting to me."

Juliet's mom has been frank with her daughter about her own experiences. "When I was 15, I had an abortion, and that's something that Juliet's known about for a long time," she says. "That's always kind of been a part of our family conversations about sex and sexuality and self-esteem."

"I think that honesty has been helpful to her as far as her understanding the way these things happen. And I think that that's a part of her response to Roe v. Wade as well. It's not an abstract concept for her."

It's also clear that sexual violence is not a remote threat for many young women around the country. A recent survey from Centers for Disease Control and Prevention found that 18% of high school girls reported facing sexual violence in the past year.

"I think it's a pretty big fear," Juliet says. She remembers walking through a neighborhood with a friend: "Every time a car driven by a man slowed down next to us, we both got scared. It's a thing I think about every day."

Her mom observes, "I think that's kind of a sad way to grow up."

After bringing Juliet's dad into the family discussion, it was decided. Juliet would start on birth control.

Weighing the options

Perhaps it goes without saying, but anyone can get pregnant starting right before their first period starts. In the U.S., that usually happens around 12 years old. Last summer, the case of a 10-year-old girl from Ohio who became pregnant after she was raped and had to travel to Indiana for an abortion made national headlines.

In states with restrictive laws, abortion can be even harder for minors to get than adults. Minors sometimes need parental permission and might have limited transportation options or financial resources. The alternative – carrying a pregnancy to term – can be hard on a young person's body, and be disruptive to their education and life prospects.

That's where contraception for teens comes in. "The average age of sexual intercourse in the United States is about 17 years old," explains Cynthia Harper, a contraception researcher at the University of California San Francisco. By the time adolescents have sexual intercourse, "over 75% of them are using a method of birth control, so the majority of them have thought about it beforehand and have gotten protection beforehand."

Mostly, young people use condoms, according to national surveys, she says, "which makes sense, they're more easily available and they don't need a prescription." They also tend to use the pill, she adds. Both options can be unreliable unless they're used correctly. Although she's hopeful the FDA will soon move to make the pill available over the counter, right now you need a prescription, which can be a major barrier.

Harper thinks young people need to have access to information about the range of options, including long-acting birth control like IUDs, shots, and implants. "Different people have different needs and that's why it's important that they find out about a lot of methods, not just the condom or just the pill," she says. It's common for sex ed to skimp on the details of contraception options, she says.

Of Juliet's decision to start on birth control because of Georgia's abortion restrictions and her fears of assault, Harper says: "Those fears are pretty intense for somebody of that age – that's really upsetting."

A shot for peace of mind

In July, Juliet's mom took her to a teen clinic in their hometown to consult with a nurse on different options. The nurse didn't recommend an IUD for someone her age. "I'm not good with pills right now," Juliet says. It can be hard to remember to take them every day, and if you forget, they're less likely to work to prevent a pregnancy. The arm implant option didn't appeal, either. "I'm just nervous about that – that scares me," she says.

That's how she landed on Depo-Provera – a shot administered in a clinic that lasts for three months. She got her first shot at that visit to the clinic in July, and she's gotten two more since then. Her parents deferred to her on the choice, taking the view that she should have control over her reproductive decisions. "I don't I don't think it's fair for me to make that decision for her," her mom says. "I wouldn't have wanted that decision made for me."

That being said, Juliet's mom is not a fan. "My big fear with Depo specifically was that it would alter her mood and there would be nothing we could do about it," she says. "And that has happened – incontrovertibly."

"It's a cost-benefit analysis situation – what makes you more anxious, the fear of not being protected should anything happen to you? Or these times where this medicine is really, really supercharging her system and she's miserable, can't sleep, can't eat?" she asks. "It's not a great place to be in, it's really not."

The logistics have been challenging. The teen clinic is set up to serve a high school across town and isn't open on weekends. Several times, her parents took her and found out the clinic was closed. Once, she had to miss school and have a family friend take her to be able to get the shot.

"It just seems like challenge after challenge being heaped on young girls," her dad says.

For Juliet, "the birth control gives me a sense of security, but it gives me really bad side effects – it makes me feel really depressed and it makes me feel really anxious," she says. It also changes her appetite for about a week after she gets it, and her periods have stopped.

Her mom notes, despite all of these challenges, Juliet is in the best position possible.

"She's got amenable parents with the means and the transportation to get her where she needs to go, the persistence to keep trying to do it. She feels comfortable talking to us," she says. "This is – in a really crappy situation – the best case scenario."

She worries about the teenagers across Georgia who don't have any of those resources, and what they're going to do – let alone teenagers in other states that restrict abortion.

For Juliet, being on birth control is worth it for the sense of protection it gives her. "Obviously, it's easier for me to be really depressed for one week than to have a baby," she says. "I don't have to worry about it as much – I don't have to think about it as much."

Copyright 2023 NPR. To see more, visit https://www.npr.org.

Selena Simmons-Duffin
Selena Simmons-Duffin reports on health policy for NPR.