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.  

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‘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........

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