"Dr. Zha, for the new OB initial visit I put on your schedule next week, is it possible to schedule the patient with you sooner?" the OB coordinator asked me.
"Why is that?" I responded, as there is usually no urgency for this type of visit.
"Well, she is only 13. And she didn't sound excited about this pregnancy. It's better if you talk to her about her options sooner rather than later."
This was one of my first new OB patients at my current job as a family medicine physician with obstetrics at a federally qualified health center in rural Washington that serves a predominantly Latinx migrant worker population. As I would come to find out, teen pregnancies are not uncommon in my patient population, similar to other marginalized groups. In 2006, 127 per 1,000 Hispanic teens (ages 15-19) became pregnant, nearly double the national rate. As of 2019, the birth rate among Hispanic teens ages 15-19 was over two times higher than the rate for white teens. Considering the disparities in education and income levels between the two groups, this is hardly surprising.
And before some readers argue that teen pregnancy and intentional young parenthood is just a "cultural thing" in certain populations, it's worth pointing out that according to national data, Hispanic people of child-bearing age have much higher rates of unintended pregnancy than their white counterparts. Women of color and undocumented immigrants are also at greater risk for rape. Expectedly, Hispanic people who are pregnant are twice as likely to undergo abortions than white people.
Teen pregnancy and births are extremely costly in several aspects. Teen births result in a substantial dropout rate from high school. The children of teen mothers have more health problems and lower school achievement, and are more likely to become incarcerated, unemployed, or teenage parents themselves. It's a vicious cycle of poverty that bleeds into multiple generations. This is not just a problem for teens of color, but a national issue for young people of all backgrounds: while the teen birth rate has been decreasing in the U.S. over the past 3 decades, it is still the highest among western industrialized countries.
Overall, about 29% of pregnancies among 15 to 19-year-olds end in abortion in the U.S. (2013). This means access to legal and safe abortion has been an important way to end the cycle of poverty for teens of color, who already experience more barriers to healthcare. Among my patient population, living in a rural location adds even greater challenges.
After confirming my 13-year-old new OB patient's pregnancy was not a result of rape, I asked her on our confidential phone call, "Would you like to keep this pregnancy?" Her answer made it clear that this was an unintended and unwanted pregnancy. In Washington, minors have the legal right to terminate their pregnancy without parental permission. So, we helped her make an appointment with the nearest Planned Parenthood, which was over an hour away by car. Luckily, we were able to provide resources to help her overcome language barriers and transportation difficulties.
On June 24, 2022, the Supreme Court overturned Roe v. Wade. This decision will likely lead roughly half the states to ban abortion. Without a doubt, my Hispanic teen patient population -- among other marginalized communities -- will be disproportionately impacted.
"What do you want to be when you grow up?" I frequently ask my teenage patients during well-child checks. A few months after my 13-year-old patient underwent medical abortion, I had the opportunity to ask her this exact question during her own well-child visit.
"I want to go to college so my parents don't have to work in the fields," she said, without hesitation.
This is a goal I hear a lot. Sometimes young patients will say this to me in English, while their exhausted, dirty, and extremely sun-burned parents who just finished working in the orchards or the farms sit quietly in the corner of the exam room. Without fully understanding what we're saying, the parents smile at me as their eyes fill with tears and their hearts with pride.
"Alright!" I cheer whenever I hear such an answer. In these moments, I am reminded of my own childhood where my parents would "break the wok to sell the scrap metal" (a saying in Chinese indicating to give away all one has to achieve something) in order to support my education and turn the fate of my family around.
We simply cannot ensure healthy and educated futures for our teens, especially those who carry the hopes and dreams of their already marginalized families, without providing them the vital tools to break the cycle of poverty. And the access to abortion is one of these tools.
Mengyi "Zed" Zha, MD, is a family medicine doctor in Washington State and a nonfiction writer.