The story of a 10-year-old rape victim who was denied an abortion in Ohio and forced to travel to Indiana for the procedure captured international headlines as one of the most shocking consequences of the Supreme Court’s decision overturning Roe v. Wade.
The case underscores the outsized impact of abortion bans on adolescents, who already face complex legal, social, and logistical hurdles accessing reproductive health services. Experts warn the justices’ decision is also likely to reverse the decades-long decline in teen birth rates, and increase stigma and shame around youth pregnancy.
“We will see additional difficulties accessing contraception, additional stigma around being sexually active, additional difficulties having open and honest conversations with trusted adults around these issues,” said Julie Maslowsky, an associate professor of community health sciences at the University of Illinois Chicago.
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A 27-year-old man in Columbus, Ohio, was arrested Tuesday and charged in connection with the rape of the 10-year-old girl. The suspect, Gerson Fuentes, is being held on a $2 million bond.
Childbearing in early adolescence — when children are typically 10 through 14 years old — is exceedingly rare in the United States. In 2020, according to the most recent available data from the Centers for Disease Control and Prevention, more than 1,700 infants were born to girls ages 10 through 14, accounting for less than half a percent of all births nationwide.
But younger adolescents receive abortions at a rate higher than any other age group — 850 abortions per 1,000 live births, according to the CDC.
Ohio is one of at least 11 states, including Texas, Oklahoma, and Missouri, severely restricting or banning abortion in the aftermath of the Supreme Court’s decision, according to the Guttmacher Institute, a reproductive rights nonprofit. Ohio’s law prohibits abortion when fetal cardiac activity can be detected — at approximately six weeks’ gestation — and only makes exceptions for mothers whose life or health are at serious risk.
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Dr. Elise Berlan, an adolescent medicine pediatrician based in Columbus, said restrictive abortion bans like the one in Ohio will disproportionately affect adolescents, who are generally slower than adults to recognize the signs of pregnancy and more likely to present later to clinicians for diagnosis and care.
“Right now, there aren’t any restrictions on our ability to provide evidence-based counseling for pregnant adolescents, so we are continuing to do what we’ve always done,” Berlan said. “However, when we have a pregnant adolescent now who desires an abortion, it’s going to be a lot more complicated.”
For most adolescents, accessing safe and confidential abortions has never been easy. Thirty-eight states, including Massachusetts, require parental notification or consent before a minor can get an abortion. Adolescents who want to avoid telling their parents can obtain a judge’s permission for an abortion, a process known as judicial bypass.
But navigating the court system, experts say, is onerous and confusing, and can cause significant delays accessing abortion. Arranging travel to clinics and paying for the procedure pose additional obstacles for young people.
“There are states that are doing their best to shore up proactive policies that protect the abortion access, but in many legal contexts, you have to really explicitly . . . make sure that policies are applied to youth as well,” Maslowsky said. “They can be easily forgotten or left out.”
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Dr. Natalie Pierre Joseph, a pediatrician, has treated fewer than a dozen adolescent mothers 14 and younger in her 21 years at the helm of Boston Medical Center’s Teen and Tot clinic, a case management program for young mothers and their children. Her youngest patient was 10.
Those patients typically started puberty and engaging in sexual activity at a far earlier age than their peers, Pierre Joseph said. In Massachusetts, minors 15 and younger cannot legally consent to sex. But most parents of her youngest patients choose not to press statutory rape charges, Pierre Joseph said, because the fathers are minors as well. Among her patients, she said, pregnancies resulting from rape by adults are rare.
Some of her youngest patients are so uninformed, they truly don’t understand how they got pregnant, she added, or “where the baby came from.”
“These adolescents are at very high risk early because they enter care very late simply because of denying the fact that they truly could be pregnant and don’t want to know,” Pierre Joseph said. “We’ve had cases coming in not until third trimester.”
Pierre Joseph (who stepped down as medical director of the clinic earlier this month to focus on her other research) said most of her youngest patients had relatively healthy pregnancies and uncomplicated deliveries, but struggled mightily in their first year as mothers with postpartum depression.
She worries adolescent pregnancies will rise in the post-Roe era, especially as girls have begun menstruating at younger ages. Many adolescents, she noted, have limited access to contraceptives and comprehensive sex education, making pregnancy prevention an even greater challenge.
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“It truly is damaging — mentally and physically — for 10-, 11-, 12-, 13-year-olds to be pregnant,” Pierre Joseph said.
The US teen birth rate has plummeted since the baby boom of the 1950s, reaching a record low in 2020, federal data shows. The abortion rate among teens 15 through 19, likewise, is down nearly 83 percent from its peak in 1988.
Dr. Aletha Akers, vice president for research at the Guttmacher Institute, attributes the steep declines to innovations in contraceptive methods and increased contraceptive use. Fewer teens are also having sex, and more are delaying sex until they’re older, she said.
“We’re most likely going to see an increase in the number of people who are seeking abortions as . . . politically we are becoming more hostile to people seeking services,” Akers said.
President Biden signed an executive order directing federal agencies to safeguard some reproductive health services, like abortion medication and emergency conception, and protect patient data. In his remarks, he invoked the case of the 10-year-old forced to travel to Indiana for the abortion.
“A 10-year-old girl should be forced to give birth to a rapist’s child?” Biden said, his voice raised. “I can’t think of anything as much more extreme.”
Fridashley Antoine, one of Pierre Joseph’s former patients, said she was lucky she had a strong support system in place when she became pregnant with her son at age 14. Antoine didn’t find out about her pregnancy until she was well into her third trimester, and a legal abortion was no longer an option. She relied on counselors and clinicians at the Teen and Tot clinic, and other Boston-based social services, to help her transition into motherhood.
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Antoine, who is now 27 and living in Allston-Brighton with her son, worries about adolescents who will be forced to become parents before they’re ready.
“Everybody wants the option to police their own bodies,” she said, “and not everyone is going to be as fortunate to have the advocacy and support I had.”
Deanna Pan can be reached at deanna.pan@globe.com. Follow her @DDpan.