Brazil Cut Teen Pregnancy With Free Birth Control. Conservatives Aren’t Happy.

This story was produced with the support of the International Women’s Media Foundation (IWMF) as part of its Reproductive Health, Rights, and Justice in the Americas Initiative.

Wearing a green gown, Yara lay drowsy in a hospital bed in Fortaleza, in the northeastern Brazilian state of Ceará. It was March of 2026, and she looked nothing like a girl who, just a few months prior, spent her afternoons playing around the neighborhood. Yara, 13, was recovering from the cesarean section she had hours before—one of the roughly 10,000 girls aged 14 and below who give birth every year in Brazil. 

On her right arm, tubes delivered IV fluids. On the left, a beige bandage covered her newly implanted birth control: Implanon, a long-acting reversible contraceptive placed under the skin of the upper arm. With Implanon, Yara, a pseudonym Rewire News Group granted to protect the minor’s privacy, would be protected against pregnancy for the next three years.

In the United States, the available long-acting contraceptive implant is called Nexplanon, and the assurance it—and other kinds of birth control—provide against unplanned pregnancy is becoming something of a luxury. Clinics that offer reproductive health-care are closing nationwide, further straining an already frail health-care system. Patients without private insurance who want long-term birth control must navigate a frail reproductive care system further weakened by recent cuts to Medicaid, Medicare, and Title X funding. 

Brazil, by contrast, has been expanding its offerings of free contraceptives since 1996. Last year, the birth control implant became universally free nationwide in the Brazilian public health-care system. In Brazil, nearly 656,000 teens gave birth in 1996. In 2025, that figure had plummeted to around 276,000—a 58 percent drop in under three decades.

But this investment in public health has not come without controversy. And no place illustrates this tension better than Fortaleza.

Implants help prevent new pregnancies in teen moms 

Brazil added Implanon to its slate of fully covered contraceptive products in 2021. Initially, under the right-wing President Jair Bolsonaro, the implant was only available to a few target groups: incarcerated women, homeless women, and sex workers. 

It became universally available in 2025, as part of the progressive President Luiz Inácio Lula da Silva’s push to address family planning in a country where more than half of pregnancies are unplanned. Until 2019, 1 in 4 mothers aged 15-29 in Brazil had conceived at least once before. Today, Brazilian women aged 14 to 49 have a legal right to access this long-term birth control method. 

Technically, 13-year-olds like Yara aren’t eligible for free Implanon at a public clinic or hospital. But they are in Fortaleza, the capital of Ceará and its largest city, with about 2.5 million people, thanks to a push to reduce teen pregnancy launched by the state government.  

‘One pregnancy doesn’t prevent the next’

When Yara first looked at her positive pregnancy test, she thought it had to be wrong. 

“But it was true,” she said in an interview with Rewire News Group. 

And she was already six months pregnant. 

Yara’s mother was also expecting: At age 33, she was carrying baby number five. Yara’s youngest sister would be born just one month before her own baby. Yara’s oldest brother is 15. 

The state of Ceará ranks eighth of Brazil’s 26 states in pregnancy among girls 14 and under, federal data shows. OB-GYN Zenilda Bruno, founder of the country’s first hospital maternity unit specialized in teen care, told RNG that she sees many families like Yara’s. 

“A mother has a baby when she’s a teen, and her daughter also has a baby when she’s a teen,” Bruno said, calling this pattern a “cycle of repetition.” 

Another pattern she’s witnessed: Very young mothers getting pregnant again.

“One pregnancy doesn’t prevent the next,” Bruno said. “It’s not a vaccine.”

According to documents obtained through a Freedom of Information request, that group includes postpartum girls as young as 12. (Previously, in 2010, Implanon had been made available free only to people with high-risk pregnancies statewide.)

Bruno is now seeing far fewer young patients in the delivery room. Between 2010 and 2024, the number of girls 14 and under giving birth in Fortaleza reduced by more than half. 

“There are even those who share the pills with a sister: ‘I’ll take one today, you take one tomorrow,’” Bruno said.  

Implanon, in contrast, is one and done. Once the hormone is implanted in the arm, it works reliably for three years—no hiding or mental math required. That’s why she thinks it’s so good for young patients.

Ground zero for political debate over birth control

When Brazil’s national government turned its attention to Implanon in 2025, Ceará had already been offering it to girls and teenagers for almost seven years. The new federal program set the minimum eligible age at 14—four years older than in Ceará. 

That difference has made Fortaleza both fertile ground for political debate and a scapegoat for conservative messaging.

Girls can get Implanon postpartum starting at 10 or 11 years old in other Brazilian cities, including Campinas, in the state of São Paulo, and Pinhais, in the southern state of Paraná. But it was the backlash against Fortaleza’s youth contraception initiative that culminated in a Brazilian Senate hearing. 

The hearing was called after the conservative Sen. Damares Alves, a vocal opponent of feminism and LGBTQ+ rights, filed a complaint with Brazil’s Public Prosecutor’s Office. In a public statement on Ceará’s program, Alves expressed concern that the country had basically “legalized pedophilia and rape” because it “failed in its mission to protect children and adolescents.”

At the three-hour session, which opened with prayers calling for “God’s protection,” health policymakers, public officials, doctors, and academic experts joined legislators to debate the legality and legitimacy of Fortaleza’s initiative. 

With the fate of girls like Yara at stake, technical data about the value of teenage contraception was met by conservative discourse painting Implanon as a threat to children and family values. 

Fortaleza was also accused of not following federal prescribing guidelines for Implanon, which limit Implanon prescription to people over 15. However, there is no one age standard in Brazil; the guidelines for Implanon vary. 

The latest guidelines from Anvisa, the Brazilian counterpart to the Food and Drug Administration, set 15 as the age threshold. In the U.S., Nexplanon’s label has no age limits. World Health Organization (WHO) guidance likewise places no age minimums on implant use after menstruation begins. 

Brazil’s major pediatrics and gynecology professional societies, meanwhile, suggest individual evaluation for girls under 14. And the Federal Medicine Council has expressed concern that the implant could negatively affect developing bodies of girls between 10 and 13 years old.

But teen pregnancy carries serious risks, too. Global data show that the younger a girl is when she gets pregnant, the higher her risk of pregnancy and birth-related death. The risks increase exponentially if she gives birth again as a teenager.   

According to the WHO, pregnant youth between 10 and 19 years of age face higher chances of eclampsia, which can cause seizures, and dangerous infections than people who get pregnant between the ages of 20 and 24. Other studies have likewise linked adolescent pregnancy with a higher risk of pre-eclampsia, or perilously high blood pressure.

“Hemorrhage during childbirth” is also a concern for girls, Bruno said.  

Babies born to adolescents face a higher chance of death in the first year of life. They also risk severe neonatal complications like low birth weight, preterm birth, and premature death. 

A few days before Yara gave birth, a prenatal exam found that her son had a potentially critical heart condition. Yara’s newborn was whisked off for monitoring immediately after birth. Yago (not his real name) celebrated his “monthversary” in the ICU. 

He has since been released, healthy, to Yara and her family. They recently celebrated his two-month birthday at home. 

Unplanned pregnancies fuel the poverty chain

Bruno and other defenders of Ceará’s Implanon program take a similarly skeptical view of another main conservative criticism aired during the Senate hearing. Birth control, Alves claimed, sends kids a message to “go ahead, you can have sex.” 

Under Brazilian law, any sexual activity with children under 14—including between two young teens—constitutes statutory rape. Offering birth control to this age range, critics argue, is admitting a failure in protecting children from predators. 

As in the U.S., Brazilian conservatives generally prefer to promote abstinence. But prohibition and denial “won’t stop [kids] from having sex” if they want to, Bruno said, “because that’s impossible.”

Nor is there any evidence that teaching celibacy prevents rape. Girls up to 13 years old represent more than 60 percent of sexual abuse victims in Brazil, according to Brazil’s Public Security 2025 report. More than half the cases take place at home, mostly committed by a family member or acquaintance. 

Pregnancy is the second main cause of school dropout among girls and women in Brazil, often as a result of economic pressure and the lack of family support. In time, that leads to lower lifetime earnings and greater economic dependence, perpetuating the cycle of poverty. 

“When we talk about the risks of teen pregnancies,” Bruno said, “we’re talking about suicide. We’re talking about interrupted education. … about separating from their partner.” 

Breaking the cycle takes more than one mother 

Lurdiane Costa, who lives in Fortaleza, was a 19-year-old high school senior when she got pregnant and dropped out of school. Four years later, the man who insisted on her having a child left them both. 

“It felt like: If the marriage is over, [then] there is no longer a child,” she said. 

In the years that followed, work and motherhood swallowed her time. Only now, at 37, she’s getting her university degree in physical education. 

“That’s not what I want for my daughter,” Costa said. 

So, sitting in the crowded waiting room at the teenage clinic in downtown Fortaleza in March, 2026, Costa accompanied her 17-year-old daughter to receive an Implanon, after one year on a waitlist. They waited there for hours, checking the high-hanging TV with the “now serving” screen. It was air conditioned, at least.

Waiting for one’s turn in the public health-care system, however long, is cheaper than paying for Implanon out of pocket. In Brazil, the implant costs around R$1,000 reais, or USD $200. That amounts to almost two-thirds of the monthly minimum wage in Brazil—and it doesn’t include the doctor’s visit fee. 

Yara’s childhood understanding was different. 

From the moment Yara started dating her 14-year-old friend, with whom she’d eventually conceive her son, she was warned by grown-ups around her “not to get pregnant.” She did know about “condoms, the pill, and stuff like that,” she said, but no one ever told her how to get—or properly use—contraception. 

There are other reasons why, 30 years after Brazil launched free contraception, many girls still can’t get it, Bruno said. Reaching the clinic often hinges on affording bus fare, securing the company of a friend for moral support, and avoiding parental interrogations.

Fear, shame, and ignorance prevent other teens from seeking contraception, she added. 

“We can’t [help] only the girls who get to us,” Bruno said, adding that her team works to reach kids wherever they can find them.

Partnerships where doctors meet with teens outside hospital and clinic walls—for example visiting schools, jails, and community events—do exist in Brazil. But inequality and political disputes, both of which run high in Brazil, often get in the way.

For Bruno, another challenge is “different concepts of education and religion.”

By that she means that in conservative Christian circles, some children will be taught sexual abstinence or nothing at all. 

Yara said she has dreams for the future. But she declined to share them.

“They’re far-fetched,” she explained, covering her eyes to hide her tears. 

At her bedside, Yara’s aunt held the girl’s hand in hers. Yara’s mom had her own baby to tend to, so her aunt has stepped in to help. Yara sighed. For now, she said, she just wants “to be here—to live with my son.” 

Contraception pays off in Brazil and the U.S. 

From a budgetary perspective, universal contraception distribution makes sense. For every unplanned pregnancy that’s avoided, money and lives are saved. 

In a country like Brazil where more than half pregnancies are unplanned, that adds up. The Brazilian government has purchased $44 million USD in Implanons; it spent $801 million on childbirth and its associated complications. 

In the U.S., the math looks similar: Investments in contraception contributed to a 69 percent drop in teenage pregnancy between 2007 and 2024. Just 1,700 girls 15 and under gave birth in the U.S. in 2024.

But the politics of birth control are swinging in a different direction. Federal funds once used to prevent teenage pregnancies are now going towards fertility under an administration that openly proclaims, “we want more babies”—even though more than one-third of U.S. counties are obstetric care deserts.

Brazil isn’t immune to similar setbacks. 

By the end of 2026, the Brazilian government plans to have delivered 1.8 million Implanons, enough to serve roughly 3 percent of women aged 10 to 49 in the country. What happens after that hinges on this October’s presidential election, which is likely to be a matchup between current President Lula and Bolsonaro’s eldest son. 

Previous right-leaning administrations, Bruno recalled, backslid on family planning and reproductive rights. If Brazilians vote a conservative president back into office, U.S.-style financial cutbacks to public health are very much on the table. 

Bruno hopes the past won’t repeat itself next year. But, she added, “anything can happen.”  

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