Minors' Right to Confidential Health Care

Questions and Answers on Minors' Access to Reproductive Health Services

What are the challenges to minors' access to confidential reproductive health services?

Many laws exist, and many have been proposed, to limit minors' access to confidential health services such as birth control and abortion. Frequently, restrictive laws impose parental notification or parental consent requirements.

Parental notification laws require doctors to notify a minor patient's parents before providing certain reproductive health services.

Parental consent laws require minors to obtain written parental consent or a court order before a doctor may provide certain reproductive health services.

What's wrong with requiring parental involvement for teenagers' access to abortion or birth control?

It just seems like common sense.

Parental involvement laws sound benign, but they are not. Fifteen years of experience in other states have demonstrated that parental involvement laws inflict physical and emotional harm on young women, especially the vulnerable teenagers from unhappy homes who most need our protection.

National surveys show that most teenagers do consult their parents when faced with unplanned pregnancies. The younger the adolescent, the more likely she is to voluntarily confide in a parent when pregnant.

Teenagers who do not reveal pregnancy to parents usually have very good reasons for maintaining their privacy. For example, some parents have rigid views on sex, birth control, and abortion; some families are in crisis from a recent event, such as a job loss or divorce; some parents are alcoholics, drug abusers or mentally ill. In dysfunctional families, parents may respond to the news of a daughter's sexual activity and pregnancy with rejection or violence.

Parental consent and notification laws do not convert abusive, dysfunctional families into stable and supportive ones. The laws simply give pregnant adolescents from unhappy homes difficult options at a difficult time in their lives. Some travel alone to other states, some navigate through a stressful and humiliating court process, some bear babies before they are ready to be parents, and some turn in desperation to self-induced or illegal abortions.

Minors can't do lots of important things, like get married. A teenager can't obtain a tattoo or have her ears pierced without her parent's permission. Why is this different?

We are not talking about a decision that can be delayed until a teenager becomes an adult, like marriage, and we are not talking about something so frivolous as ear piercing or tattoos. We're talking about whether a teenager will be forced to have a baby against her will—a profound, life-altering event.

But parental consent is always required for children's medical care, isn't it?

The school nurse can't give a teenager an aspirin without her parent's permission.

Are you saying that abortion should treated differently from comparable medical care?

No. Parental involvement laws actually treat abortion differently from comparable services.

All states have “medical emancipation” laws that guarantee teenagers confidential access to health care related to intimate behavior, such as sex and drugs. For example, teenagers may obtain treatment for as sexually transmitted diseases, birth control, pregnancy, drug or alcohol abuse, AIDS, sexual assault and mental illness without parental notification or consent in California.

These laws exist because teenagers simply won't obtain vitally needed care if they need to reveal their experience with sex, drugs or alcohol to their parents. A Journal of Pediatrics study found that only 15% of teenagers would seek treatment for sexually transmitted diseases if they were forced to obtain parental consent. The number jumps to 50% when treatment is confidential. In another study, published ion Family Planning Perspectives, 25% of students said that they would simply not obtain health care if there were a chance that their parents would find out. These kinds of barriers create serious health problems, both for young people and for the public.

But abortion is surgery; it seems different and more dangerous than those other health care services that teenagers can obtain on their own.

Abortion is an extremely safe procedure—safer than receiving a penicillin shot in a doctor's office. Abortion is 10 times safer than continuing a pregnancy and delivering a baby—which the law allows teenagers to do with no parental involvement. The law even allows teenagers to consent to Caesarean section deliveries by themselves. Abortion is less dangerous for teenagers for adult women, while childbearing is more dangerous for teenagers than adult women. And having a baby poses far greater risks to a teenager's emotional well-being, education, and life prospects than ending an unplanned pregnancy.

But surely we want teenagers to come to their parents when they are faced with something as important as an unintended pregnancy.

Absolutely!

When teenagers seek care by themselves, doctors and nurses strongly urge them to involve their parents. The majority of teens do confide in their parents when faced with a problem pregnancy. More than 90% of teens under 14, and 74% of 16-year-olds, tell at least one parent. But some teens just can't talk about sex without endangering themselves and their family relationships.

The law can't mandate good family communication. Studies that have compared states with parental involvement laws to states without these laws have shown no statistical difference in the percentage of teenagers who told their parents about their pregnancies and abortions. Parents must talk openly with their children about sex, so that adolescents will feel safe confiding in their parents when they have questions or problems later. Teenagers who cannot safely talk to their parents about sex must be able to obtain health care when they need it.

But won't teenagers without parental guidance go to abortion mills, which push teens into abortion so that they can make a profit?

First, most teenagers who cannot involve their parents do confide in a trusted adult—an aunt, a grandmother, a clergy official, a teacher, a family friend. They are not all alone.

Second, family planning clinics offer sensitive counseling that does not push any client into a decision. Health professionals legally must, and do, describe the risks and benefits of all pregnancy options so that the pregnant woman can make her own decision. There is no evidence that doctors are nurses are acting unethically and illegally in providing reproductive health services. If any clinics were forcing abortions on patients, the State should revoke their licenses—not impose barriers to all teenagers' care.

Doctors and nurses at family planning clinics are particularly patient and sensitive when counseling teenagers. The only course of action they do strongly encourage is that teenagers talk to parents; counselors urge teens not to assume that parents will be furious, and even offer to help teenagers approach their parents.

Are teenagers capable of making sound decisions about pregnancy, abortion and birth control?

Yes.

Many studies confirm that teenagers are capable of deciding whether they are ready to have a baby, and of giving informed consent to abortion or prenatal care. Doctors who have worked with teenagers for years say that they almost never see a patient who is unable to understand her options and make sound choices. In the extremely rare case of a developmentally delayed teen (or adult), a doctor would not perform an abortion on a patient incapable of giving informed consent.

Won't parental involvement laws decrease teen pregnancy rates?

No. Anti-choice politicians make this claim based on a single discredited study from Minnesota, funded by the anti-abortion movement. The study showed pregnancy rates decreasing in Minnesota while the parental involvement law was in effect—at a time that they were decreasing nationwide. But teenagers did not even know of the existence of the law, so it could not have been the reason that pregnancy rates were decreasing. The Minnesota study has never been replicated elsewhere.

More recent studies have shown no decrease in pregnancy rates resulting from parental involvement laws. The studies have uniformly shown only negative results in teen health resulting from those laws: because the barriers erected by the laws cause teenagers to delay in obtaining health care, a greater percentage of teens obtain riskier and more complicated second-trimester abortions in states with parental involvement laws.

There are many effective ways of reducing teen pregnancy rates, such as comprehensive sex education and access to contraceptives. Erecting barriers to teenagers' access to health is an ineffective, punitive and dangerous way of discouraging teen pregnancy.

But don't parents have both legal obligations and legal rights to control their daughters?

Parents have many rights—but they cannot force their daughters to have babies, just as they cannot force their daughters to have abortions.

Parental involvement laws do not guarantee that pregnant teenagers will confide in their parents. The laws are unconstitutional unless they contain a “judicial bypass”—a way for teenagers to avoid talking to their parents at all. Teenagers may go to court and get court orders allowing them to have abortions. That is why the numbers of teenagers who tell their parents that they are pregnant is no higher in states with these laws than in states without them. Teenagers who cannot safely confide in their parents will not do so: they will go to court, go out of state, have babies unwillingly, or turn in desperation to illegal or self-induced abortions.

Why doesn't this court option take care of the teenagers who come from violent or dysfunctional families?

When a teenager needs health care, she should not be embroiled in a legal proceeding. Going to court is time-consuming, complicated and intimidating. Teenagers are understandably fearful of confiding intimate details about pregnancy and abortion with a black-robed stranger. Some teenagers will never make it to court. They tend to be the youngest, less resourceful teens—the ones who are also least ready for parenthood.

Judges who have presided over the teenage abortion cases in states with parental involvement laws have said repeatedly that they do not help teenagers make medical decisions; the court is simply a barrier to health care. Doctors and nurses echo these thoughts: they say that teenage patients who need to go to court before getting care are too distracted and fearful to concentrate on their health needs.

Judges who faithfully follow the law feel like “rubber stamps”—they approve almost every petition, either because they find that the teenager is sufficiently mature to make her own decision, or that, if she is immature, it is not in her best interest to become a parent. But some judges do not follow the law: they veto teenagers' decisions because of the judges' own ideological views about teen sex or abortion. Government officials should not have the power to force teenagers to bear babies against their will.

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