Family Communication Resources

QUESTIONS & ANSWERS

Teens' Access to Confidential 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.

Won’t required parental consent for reproductive health services improve communication between teens and their parents?

No.

Laws 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.¹ Parents must talk openly with their children about sex so that they 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.
No studies show that forced disclosure results in improved parent-child relationships, improved communication, or improved satisfaction with the decision about pregnancy outcome.²
Legislation mandating parental involvement does not achieve the alleged intended benefit of promoting parent-child communication, but it does increase the risk of harm to the adolescent by delaying access to appropriate medical care.³

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 tested for a sexually transmitted disease or 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 reproductive health care should be treated differently from other medical care?

Yes.

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 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 some 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.⁴ In another study, published in 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.⁵
Parental consent and notification laws do not convert abusive, dysfunctional families into stable and supportive ones. The laws simply give adolescents from unhappy homes difficult options at a difficult time in their lives. Some pregnant teens 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 illegal or self-induced abortions.

But aren’t parents responsible for the well being of their children?

Of course, parents are responsible for their children and most teens do involve their parents in reproductive health decisions. We can all agree, though, that what is most important is the health and safety of our children. This is why we must ensure that teens have confidential access to health care professionals when they can’t, for whatever reason, come to their parents.

What’s wrong with requiring parental involvement for teenagers’ access to abortion or birth control? It just seems like common sense.

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 sexual activity or pregnancy to parents usually have very good reasons for maintaining their privacy. For example, some parents have strong views on sex, birth control, or 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 explosive news of a daughter’s sexual activity or pregnancy with rejection or violence.

Won’t required parental consent for reproductive health services result in less teen pregnancy and abortion?

No.

This claim is based on a single discredited study from Minnesota, funded by the anti-abortion movement.⁶ 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 obtaining health care, a greater percentage of teens obtain riskier and more complicated second-trimester abortions in states with parental involvement laws.⁷
In California, teen pregnancy and abortion rates have declined over the last four years - and that’s happened without required parental consent for reproductive health services. We must fight teen pregnancies through sex education and contraceptive availability. Government mandates will not accomplish a reduction in teen abortions.

Abortion is a medical treatment. All medical treatments involve risk. Don’t parents have the right to know about their teen’s abortion so they can respond to complications?

The majority of teens do confide in their parents when faced with a problem pregnancy. A 1991 study of unmarried minors having abortions in states without parental involvement laws found that 61% told one or both parents about their intent to have abortions. In fact, the younger the teen, the more likely it is that she will tell at least one parent (90% of teens under 14, and 74% of 16-year-olds, told at least one parent).⁸ Teens who do not reveal their sexual activity usually have good reasons for not doing so, such as a family history of abuse and violence.
Presently the death rate from abortion at all stages of gestation is less than 1 per 100,000 procedures⁹ (the risk of death from tonsillectomy is about twice that high). The risk of death associated with childbirth is about 10 times as high.¹⁰

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

No.

Most teenagers who cannot involve their parents do confide in a trusted adult—an aunt, a grandmother, a member of the clergy, a teacher, a family friend. They are not all alone.
Family planning clinics and private physicians 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.
Doctors and nurses in family planning 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.
More than 70% of all abortions are performed in private physicians’ offices.

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.¹¹ 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.
Currently, no state requires parental permission for a teen to carry a pregnancy to term and become a parent herself.¹²

Judicial bypass is a procedure frequently incorporated in parental notification and consent laws. It allows a judge to decide whether a young woman is mature enough to make the decision to have an abortion or whether it is in her best interests not to involve her parents. Doesn’t such a process protect teens who can’t go to their parents?

No.

Going to court is usually intimidating to even the most sophisticated adults, who generally have an attorney to represent them. For a pregnant teen to use judicial bypass, she must not only find a judge, she must work her way through a confusing legal system and face intense, sometimes judgmental, and often traumatic questioning by strangers. Indeed, the poorest, youngest, least experienced teenagers are least able to use judicial bypass, and thereby become the most likely to end up becoming teen parents or victims of black-market abortion.¹³
According to judicial bypass laws, a judge should decide whether the young woman is mature enough to make the decision to have an abortion or whether it is in her best interests not to involve her parents. They do not address how this young woman will be able to make parental decisions for a child of her own if she is legally barred from making them for herself.¹⁴
Restrictive laws give judges the power to say no to a teen’s private decision to have an abortion. In response, she may feel forced to have a baby against her wishes; her parents may turn their backs on her or force her out of their home; or she might run away from home to face her pregnancy alone.¹⁵
Judges who have presided over 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.

¹Blum, "The Impact of a Parental Notification Law on Adolescent Decision-Making," 77 American Journal of Public Health 619 (1987).
² American Academy of Pediatrics, "The Adolescent's Right to Confidential Care When Considering Abortion," Pediatrics, (1996).
³ Ibid.
⁴ Andrea Marks et al., "Assessment of Health Needs and Willingness to Utilize Health Care Resources of Adolescents in a Suburban Population," 102 Journal of Pediatrics 459 (1983).
⁵ D. Hollander, "Some Teenagers Say They Might Not Seek Health Care if They Could Not Be Assured of Confidentiality," 25 Family Planning Perspectives 187 (1993).
⁶ Rogers, "Impact of the Minnesota Parental Notification Law on Abortion and Birth," 81 American Journal of Public Health 294 (1991).
⁷ Henshaw, "The Impact of Parental Consent for Minors' Abortions in Mississippi," 27 Family Planning Perspectives 120 (1995).
⁸ Henshaw, SK, Kost, K. "Parental Involvement in Minors' Abortion Decisions" 24 Family Planning Perspectives 196-207, 213 (1992).
⁹ Paul, Maureen, et al., A Clinician's Guide to Medical and Surgical Abortion. New York: Churchill Livingstone. (1999).
¹⁰ Alan Guttmacher Institute, "Facts in Brief: Induced Abortion" (1998).
¹¹ American Psychological Association, Interdivisional Committee on Adolescent Abortion, "Adolescent Abortion: Psychological and Legal Issues," 42 American Psychologist 73 (1987).
¹² Rebecca Saul, "The Child Custody Protection Act: A 'Minor' Issue at the Top of the Antiabortion Agenda" The Guttmacher Report, (1998).
¹³ National Abortion Federation "Teenage Women, Abortion and the Law" 1995.
¹⁴ Ibid.
¹⁵ Ibid.