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 years old, she is in ninth grade and she has a lot to do. She learned to drive, played tennis, took a serious interest in the flute in the marching band, and took two AP courses. She is also totally indifferent to dating and sex. “I don’t think it’s interesting,” she says.
The conversation with her aunt made her realize that there were “a bunch of different types of birth control that I didn’t know existed,” Juliet says. (NPR only uses her first name to protect her privacy as a minor speaking out about her sexual health.)
She had had sex education at school – in Georgia, it is not required to be exhaustive and should emphasize abstinence before marriage. She says she didn’t learn much about birth control options beyond the pill.
Then, at the end of June 2022, a few weeks after this conversation with his aunt, Roe vs. Wade was overturned by the Supreme Court. Georgia passed a trigger law in 2019, which is now in effect and prohibits abortion after six weeks, before many people find out they are pregnant. There is an exception for rape, but only with a police report.
Because of the new law, Juliette and her mother started talking about birth control. Her mother thought Juliet could pass the information on to her sexually active friends. “It didn’t occur to me that she was wondering at all,” her mother said. But she noticed that her daughter seemed anxious and stressed, and soon Juliette told her mother that she also wanted to start birth control.
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“I don’t think anyone expected me to want birth control,” says Juliet. “I just didn’t want to have to worry so much – if I ever got raped, which I hope won’t happen, but if it ever did and I didn’t take birth control, there would be Lucky I have to keep the baby.”
“I feel like after everything that’s happened,” she says – with Roe vs. Wade overturned and the six-week ban taking effect – “I just wanted to be a little in control.”
Just one more stressor
Juliet expected her mother to say no to birth control. “We talked about it before and it seemed like she was quite against it because it can mess with your hormones,” she says. “I don’t think someone as young as me is the norm to participate in it.”
It is true that his mother hesitated. “It’s not something I like,” she said. “[Juliet] experienced COVID while in college — it hit at the end of sixth grade. She’s had really, really bad bouts of depression, and I just – I was scared to death of what [birth control] could do to him emotionally.”
Still, she could tell that Juliet was truly upset by the Supreme Court’s decision and the sudden loss of access to abortion in her home country.
“You seemed so anxious,” she told her daughter. “You just felt like you couldn’t control your own life – and that was so upsetting to me.”
Juliette’s mother has been candid with her daughter about her own experiences. “When I was 15, I had an abortion, and that’s something Juliet has known for a long time,” she says. “It’s always been part of our family conversations about sex, sexuality and self-esteem.”
“I think the honesty has been helpful to her in that she’s understood how these things happen. And I think that’s part of her response to Roe vs. Wade Also. It’s not an abstract concept for her.”
It is also clear that sexual violence is not a distant threat to many young women across the country. A recent survey by the Centers for Disease Control and Prevention found that 18% of high school girls said they had been victims of sexual violence in the past year.
“I think that’s a pretty big scare,” Juliet says. She remembers driving through a neighborhood with a friend: “Every time a car driven by a man slowed down next to us, we were both scared. It’s something I think about every day.”
Her mother observes, “I think it’s kind of a sad way to grow up.”
After bringing Juliette’s father into the family discussion, the decision was made. Juliette would start birth control.
Weigh the options
It may go without saying, but anyone can get pregnant just before their first period starts. In the United States, this usually happens about 12 years old. Last summer, the case of a 10-year-old girl from Ohio who became pregnant after being raped and had to travel to Indiana for an abortion made national headlines.
In states with restrictive laws, abortion may be even harder to obtain for minors than for adults. Minors sometimes need parental permission and may have limited transportation options or financial resources. The alternative – carrying a pregnancy to term – can be hard on a young person’s body and disrupt their upbringing and life prospects.
This is where birth control for teens comes in. “The average age of sexual intercourse in the United States is around 17,” explains Cynthia Harper, a contraception researcher at the University of California, San Francisco. By the time teens have sex, “more than 75% of them are using some method of contraception, so the majority of them have thought about it beforehand and got protection beforehand.”
Most young people use condoms, according to national surveys, she says, “which makes sense, they’re more readily available and they don’t need a prescription.” They also tend to use the pill, she adds. Both options may not be reliable unless used correctly. While she hopes the FDA will soon make the pill available without a prescription, you do need a prescription right now, which can be a major hurdle.
Harper believes young people need access to information about the range of options, including long-acting contraceptives like IUDs, injections and implants. “Different people have different needs and that’s why it’s important that they learn about many methods, not just the condom or the pill,” she says. It’s common for sex educators to skimp on the details of birth control options, she says.
Of Juliet’s decision to start birth control because of Georgia’s abortion restrictions and her fears of assault, Harper says, “Those fears are pretty intense for someone that age – it’s is really upsetting.”
A shot for peace of mind
In July, Juliet’s mother took her to a teen clinic in their hometown to see a nurse about options. The nurse did not recommend an IUD for someone his 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 are less likely to work to prevent pregnancy. The arm implant option didn’t appeal either. “I’m just nervous about it – it scares me,” she said.
That’s how she landed on Depo-Provera – a clinic-administered vaccine that lasts three months. She received her first injection during that clinic visit in July, and has had two more since. Her parents left it up to her to choose, believing that she should have control over her reproductive decisions. “I don’t think it’s right for me to make this decision for her,” her mother said. “I wouldn’t have wanted that decision to be made for me.”
That said, Juliet’s mom isn’t a fan. “My big fear with Depo was specifically that it would alter his mood and there was nothing we could do about it,” she says. “And it happened – unquestionably.”
“It’s a cost-benefit analysis situation – what makes you most anxious, the fear of not being protected if something happens to you? Or those times when this drug really, really supercharges her system and she’s miserable, can’t sleep, can’t you eat?” she asks. “It’s not a good place to be, it really isn’t.”
The logistics were difficult. The teen clinic is designed to serve a high school in the city and is not open on weekends. Several times her parents took her away and found that the clinic was closed. Once she had to miss school and ask a family friend to take her so she could get vaccinated.
“It seems like challenge after challenge is falling on the young girls,” her father said.
For Juliet, “birth control gives me a sense of security, but it gives me really bad side effects – it makes me really depressed and it makes me really anxious,” she says. It also changes her appetite for about a week after receiving it and her periods have stopped.
Her mother notes that despite all these challenges, Juliette is in the best possible position.
“She has docile parents with the means and the transportation to get her where she needs to go, the perseverance to keep trying. She feels comfortable talking to us,” she says. “That’s – in a really shitty situation – the best-case scenario.”
She worries about teens all over Georgia who don’t have any of these resources and what they’re going to do — not to mention teens in other states who 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 a 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.”