Tennessee already ranks in the top 10 for teen births. Advocates are worried the rate could increase.

Cicely Wilson’s work doesn’t end when she leaves her day job as a lactation consultant, doula, and child care expert.

Wilson founded a nonprofit called Sunnyside Up Youth Pregnancy Services, which connects girls ages 13 to 19 with resources they need to care for their babies. After-hours, she looks for affordable Nashville apartments, books medical appointments, tries to find strollers and other baby supplies, and hosts conversations with pregnant teens about breastfeeding and preparing mentally for childbirth.

Since the overturning of Roe v. Wade just over a year ago, Wilson said, she is confident that more Tennessee teens will carry their pregnancies to term. “Because the access isn’t there,” she said. “I do anticipate that we’re going to get a lot more teens that are wanting to parent their babies rather than going to Illinois or Georgia or Florida.”

Demand for services like Wilson’s could rise in the coming years even though the national teen birth rate has declined dramatically over the past three decades. It’s still dropping, but preliminary data released in June by the Centers for Disease Control and Prevention shows the descent may be slowing.

Doctors, service providers, and advocates say they’re worried full CDC data released later this year — which will include state-by-state numbers — could show a rise in teen births in many Southern states, where rates remain among the highest in the country. They say several factors — including the Supreme Court’s decision to strike down federal protections for abortion rights, intensifying political pushback against sex education, and the impact of the covid-19 pandemic on youth mental health — could start to unravel decades of progress.

“It’s absolutely concerning,” said Laura Andreson, an OB-GYN in Franklin, Tennessee. The women’s health practice where she works is treating more pregnant teenagers than in recent years, which she thinks could reflect an emerging trend.

“It’s probably going to take a little bit of time,” she said. “But I would venture to say we’re going to see it every year: It’s going to go up.”

Nationally, the rate of teen births has dropped by 78% since a modern-day peak in 1991 of 61.8 births per 100,000 people, according to the CDC. Starting in 2007, the rate had consistently dropped by about 8% until 2021, when the rate of decline slowed to about 2%.

“It certainly does stand in contrast to what we’ve seen in prior years,” said CDC researcher Brady Hamilton. He is working on the updated version of the national data released in June that will break it down by state. Hamilton said that he can’t comment on the recent social and political factors at play, but that the “phenomenal decline” in the teen birth rates over more than 15 years could be reaching a natural plateau as states achieved their goals.

“There are a lot of states that have very low birth rates,” he said. “So you kind of potentially run into a situation where they’re already low and you really can’t go lower.”

But advocates say this leveling off could be the writing on the wall, signaling the start of a rise in teen births.

“We know that young people came back from the pandemic with record levels of mental health struggles, which can be very tied to things like teen pregnancy,” said Jen Biundo, senior director of research and policy at Healthy Futures of Texas, a nonprofit that advocates for science-based education to curb teen pregnancy. A person with mental health issues may be more likely to form unhealthy relationships and engage in riskier sexual behaviors, she said.

And the decision to strike down abortion rights unleashed a sea change of legislation across the nation affecting reproductive health and options for women. States like Tennessee enacted so-called trigger laws, overturning the right to most abortions. In August, an all-male South Carolina Supreme Court upheld what abortion opponents sometimes call a “fetal heartbeat law,” which bans most abortions after about six weeks of pregnancy. The term is a misnomer because a fetus’ heart is not fully developed in the early stages of pregnancy.

The sudden shift in the reproductive health landscape concerns Hannah Lantos, a researcher who specializes in maternal and adolescent health for Child Trends, a nonprofit research center. She said changes in abortion policy likely won’t have major effects on teen birth statistics because most abortion patients aren’t teenagers. Teenagers account for only 9% of abortions and 6% of all pregnancies reported in the U.S. each year, according to a report by Child Trends. Yet about 1 in 4 teens who do get pregnant in the U.S. will opt for an abortion, according to the Department of Health and Human Services.

Previous declines in the teen birth rate weren’t driven by access to abortions alone, Lantos said. Other factors like increased access to and more effective contraceptive methods and sex education contributed. Now, those tools also are under siege in many states.

In Texas, some school boards have banned sex education curricula amid backlash from parents. In New Hampshire, Republican state officials blocked more than $600,000 in federal sex ed funding, and officials in Miami-Dade County, Florida, banned new sex ed books. In Idaho, lawmakers told the state’s health departments the state would no longer fund adolescent pregnancy prevention programs.

Parents who oppose abortion could prevent their children from getting one. Even if the parents acquiesce, incentive for a teen is low, said Wilson of Sunnyside Up. People might need to travel hundreds of miles for abortion care now. That’s particularly tricky for teenagers, who may be too young to make decisions independently.

“That car ride can be very excruciating,” Wilson said, noting that the drive from Nashville to the nearest abortion clinic — in Carbondale, Illinois — can take seven hours. “That’s seven hours of potential silence. That’s seven hours of tension. That’s seven hours of thinking about what’s next. And that is a long time to process something so difficult.”

The fear of a disapproving parent might also prevent a teenager who decides to keep the baby from revealing the pregnancy early on, Andreson said. That could lead to a lack of prenatal care, which is concerning for teens, given they are more likely to have complications than other expectant mothers.

“Their bodies aren’t designed to have babies yet,” she said. “And this doesn’t even go into all the issues that go on once the baby’s born.”

Wilson, from Sunnyside Up, noted that teenage parents face unique challenges taking care of newborns. “It’s a lot for them,” Wilson said of the teens who seek her help. “They need that hands-on, in-person support.”

And one of the greatest challenges is housing. Teenagers need a co-signer on a lease. Even when they find a place, the median rent in Nashville is over $2,000 a month, and Tennessee observes the federal minimum wage of $7.25 an hour. Sunnyside Up has persuaded clients to become roommates.

“It’s like we’re literally having to stack families together in the same household for them to be able to pay basic living expenses,” Wilson said.

This story is part of a partnership that includes WPLN, NPR, and KFF Health News.

KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.